Historical context of mental health

Question 1

Supernatural explanation 6500BC

Answer 1

1) people believed evil spirits were trapped inside individuals

2) as a punishment from Gods for misdeeds and wrong-doing

Treatment
= exorcisms
= trephination (drilling holes in heads to release evil spirits)

Question 2

Humoral theory 800BC

Answer 2

1) Hippocrates suggest mental illness have biological causes

2) Caused by imbalances of four bodily humours eg. blood, yellow bile, black bile, phlegm

Treatment - balancing fluids
Emetics - drugs to induce vomiting
Bloodletting - withdrawal of blood

Question 3

Psychogenic Approach 1800s-1900s

Answer 3

1) Mental illness was due to psychological factors

2) Freud supported this by suggesting its related to unconscious processes in the mind

Treatment
= Psychoanalysis - uncovering unconscious desires
= Free association - express thoughts freely

Question 4

Somatogenic approach Mid-late 1900s

Answer 4

1) Physical explanations of mental illness eg. abnormal brain structure and genes

2) Serotonin neurotransmitter linked to depression & anxiety
Smaller hippocampus linked to aggression

Treatment
Electroconvulsive therapy - electric currents passed through brain

Drug therapy - Seroxat which changes levels of neurotransmitters in brain

Psychotherapy - part of brains removed

More scientific
> test using MRI cause of brain structures

Question 5

How to compare similarities between historical views

Answer 5

Debates
= eg. scientific, free will/determinism, reductionism/holism, ethical considerations

Causes
Biological vs Non biological

Question 6

Aim and Sample of Rosenhan

Answer 6

AIM - to see whether the sane can be distinguished from the insane using the DSM classification system

wanted to see whether clinicians can tell difference between a patient suffering with a real mental disorder vs healthy ‘pseudopatient’

SAMPLE - participants were patients and staff in 5 different states across America in early 1960s. 12 hospitals were used which varied in size, funding and age (generalisable)

Participant observation - pseudo-patients pretended to be real patients, interacted with staff in hospital and recorded activity

Question 7

Study 1 - Procedure + results + conclusion

Answer 7

1) 8 voluteers including Rosenhan, pretended to be suffering with mental disorder so can be admitted to psychiatric hospital

2) All arrived at different hospitals reporting single symptom ‘hearing voices saying ‘empty’ + ‘hollow’ + ‘thud’. Gave real info about themselves eg. families but gave false name + false occupation (if medical)

3) As soon as they arrived as 8 pseudopatients were in hospitals, they behaved normally

Results
All pseudopatients were admitted (not sane).
Average 19 days before they were released.
One was given diagnosis of schizophrenia in remission + take anti-psychotic drugs
Nurses and doctors mingled with patients as little as possible and little contact time

Conclusion
= psychiatric hospital’s were unable to distinguish those who were sane from insane and that DSM is not a valid measurement of mental illness

Question 8

Study 2 procedure + results + conclusion

Answer 8

Procedure -
1) staff at one of hospitals were informed of results and found his results hard to believe
2) Rosenhan said in the next 3 months, one or more pseudopatients would attempt to be admitted
3) staff completed a questionnaire using a 10 point scale where 1 reflected high confidence patient was pseudopatient

Results
= 41/193 were judged to be psuedopatient by at least one staff member
= None of pseudopatients were sent to hosiptal

Conclusion
= hospital staff didn’t want to make same errors so went to far other way
= overlap between sane and insane and people can be incorrectly diagnosed

Question 9

Rosenhan’s experience of hospitalisation

Answer 9

= staff stricly degregated - own living space, bathrooms, dining facilities

= only emerged to give medication, conduct a therapy, group meeting

= doctors were even less available and rarely seen on wards -

Question 10

Generalisability of Rosenhan

Answer 10

+ range of hospitals around America, using different methods of fundings
+ more generalisable to other psychiatric hospitals at that time in America

• ethnocentric as only looked at diagnosis and hospitals in America

Question 11

Reliability of Rosenhan [6]

Answer 11

+ psuedopatients reported same symptoms ‘empty’ ‘hollow’ ‘thud’

+ quantitative data eg. how many days psuedopatients spent in hospital, how many times they were ignored - objective and reliable

• qualitative descriptions of pseudopateints would be subjective and unreliable
• went to different hospitals so they didn’t have standardised procedure
• if repeated now, won’t be similar results as DSM has been revised eg. DSM-5

Question 12

Applications of Rosenhan/ How Mental Hospitals have improved since Rosenhan

Answer 12

+ raised awareness of flaws in psychiatric diagnosis > led to improved diagnostic systems eg. DSM-5 has improved diagnosis

+ improvements in way patients are treated in hospitals - increased contact time between staff and patients

Question 13

Validity of Rosenhan [6]

Answer 13

HIGH ECOLOGICAL VALDITY
+ conducted in 12 real psychiatric hospitals across multiple states

+participants were real staff in psychiatric hospitals, unaware they were being observed so showed real behaviour

LOW ECOLOGICAL VALIDITY
- pseudopatients weren’t really insane so experiences don’t reflect those of regular patients

• could’ve been bias in observations made by pseudopatients
• pseudopatients spent a lot of time writing down observations on ward,staff, patients which is activity not normally indulged by genuine patients
• psychiatrists would be careful to release someone too quickly when they’ve just been admitted
  > reduces validity as its not due to incorrect diagnosis but just cautious psychiatrists

Question 14

Ethics in Rosenhan

Answer 14

integrity - staff members were deceived

responsibility - protection from harm ( reputation damaged. embarrassed, no debriefing

respect - no informed consent and no right to withdraw (in study 2 consent was involved)

however, Rosenhan did protect anonymity of staff+hospitals afterwards

Question 15

Rosenhan + socially sensitive research [6]

Answer 15

+ considered as socially sensitive because it questions accuracy of diagnosing mental disorders eg. schizophrenia,
+ could lead to distrust of psychiatry

+ Rosenhan and other 7 volunteers visited 12 psychiatric hospitals pretending to be ill by saying they heard voices ‘empty’ ‘hollow’ ‘thud’. All of them were admitted, wrongly diagnosed as schizophrenic

• there are positive implications of Rosenhan’s research
• led to improved diagnostic systems eg. DSM is constantly revised and improved
• led to patients in hospital being related more humanly

Question 16

Explain how Rosenhan’s study demonstrates the problems with categorising mental disorders [5]

Answer 16

1) suggests that when people are categorised with a mental disorder using diagnostic systems eg. DSM, the diagnosis lacks validity

2) DSM III was used in Rosenhans study to diagnose pateints. Pseudopatients were mostly diagnosed with schizophrenia after reporting hearing ‘empty’ ‘hollow’ ‘thud’

3) Psychiatrists could not tell pseudopatients were sane and did not have schizophrenia

4) The diagnosis was also difficult to escape and they were released with diagnosis ‘schizophrenia in remission’ so Rosenhan’s study shows problems with categorising mental disorders

Question 17

How did Rosenhan explain the behaviour of the abusive staff [3]

Answer 17

= Staff felt in a position of power over the patients and this may have led them to believe they could abuse patients

=Staff may have neglected or been rude to patients because they saw them only as patients with schizophrenia and not people with families + lives outside institution

= Staff may have been dismissive to patients as they felt there were no consequences for them as no one would believe what a patient says

Question 18

Describe ways in which they key research by Rosenhan could have been improved [6]

Answer 18

1) if it had used hospitals in other countries

2) to see whether there are differences in diagnosis of patients or how much label of schizophrenia is stuck with them

4) if it had used pseudo patients reporting a different disorder eg. depression

5) to see if there are differences in diagnosis of people with depression and if label sticks as much as schizophrenia

6) this would improve research by making it more generalisable to other disorders. DSM could be valid for other disorders

Question 19

With reference to key research, discuss how classification of mental illness can result in ‘stickiness of labels’ [5]

Answer 19

1) when people are given a label of a mental disorder it can be hard to escape the label

2) once patients had been admitted with schizophrenia diagnosis, none of staff questioned the label

3) even when they acted sane, the label stayed with them and they were treated as having the label

4) eg. when they were writing in their diaries this was interpreted as insane behaviour

5) when they were released, they were released with ‘schizophrenia in remisson’ and had to take antipsychotic drugs

6) This shows the label was used to explain everything they did and ‘sticks’ with them

Question 20

With reference to key research, explain why patients have experienced depersonalisation and powerlessness in psychiatric hospitals [5]

Answer 20

1) if there is little interaction between staff and patients this leads to feelings of depersonalisation

2) in Rosenhan’s study found doctors spent very little time with patients (6.8 minuities per day)

3) nurses and doctors at hospitals made little eye-contact with patients so led to patients feeling a sense of depersonalisation (feeling emotionally disconnected from people)

4) the patients freedom of movement was restricted, personal privacy was kept to minimum

5) attendants verbally and physically abused the patients
(one beaten up for telling them ‘I like you’)

6) There was a sense that if patients reported the abuse they wouldn’t be believed so made them feel powerless

Question 21

Rosenhan contributing to individual, social and cultural diversity

Answer 21

INDIVIDUAL
= 35 patients suspected psudopatients of faking symptoms in study 1
= study 2 there were differences between members of staff and their rating of whether patients were pseudopatients

SOCIAL
= one social group (staff) behaved differently from another social group (patients)

CULTURAL
= one culture USA mental disorders were misdiagnosed and how patients were largely ignored in hospitals

Question 22

Discuss the usefulness of Rosenhan’s research [5]

Answer 22

1) highlighted the little contact between staff and patients + misdiagnosis of mental disorders

2) led to improvements in psychiatric hospitals and classification systems eg. DSM (constantly revised)

3) increased contact time between staff and patients and how to treat them

Question 23

Explain why Rosenhan’s study has sampling bias [4]

Answer 23

= range of hospitals around country, old & new, different methods of funding

= generalisable to other psychiatric hospitals at time in America

= not applicable to psychiatric hospitals now as improvements in treatment of psychiatric patients

= conclusion DSM lacks validity can’t apply to modern day due to DSM being constantly revised

= ethnocentric as only looked at diagnoses in America. views about abnormal behaviour and how to treat it differ between cultures

Question 24

Definitions of Abnormality

Answer 24

Statistical infrequency definition of abnormality

Deviation from social norms definition of abnormality

Failure to function adequately definition of abnormality

Deviation from ideal mental health definition of abnormality

Question 25

Statistical infrequency definition of abnormality
= definition
= +ves & -ves

Answer 25

Behaviour that occurs infrequently in population is considered abnormal

eg. behaviour that less than 5% of population shows mental illness
eg. 15 yr girl whose calorie intake in more than 2 standard deviations from the mean

+ objective way of measuring abnormality

• some statistical infrequent behaviour is desirable eg, IQ over 130 but not considered mental disorder
• not take into account if someone needs help

Question 26

Deviation from social norms definition of abnormality
= definition
= +ves & -ves

Answer 26

Standards of acceptable behaviour are set by a social group
Anything that deviates is considered abnormal e.g.. talking to yourself in public

+ takes into account culture as any society has own set of social normas

• social norms change overtime so cant be used to explain mental disorder as not objective (homosexuality was mental disorder)
• culturally specific - differs from generations and ethnics, socio-economic groups

Question 27

Failure to function adequately definition of abnormality

• definition
  +ves and -ves

Answer 27

Judges people as abnormal if they are unable to cope with demands of everyday life + live independently in society

also if failure to function adequately causes them or others stress

+ takes into account whether someone is coping with everyday life and whether they need help

• subjective as peoples opinions on whether someone is functioning adequately or not

Question 28

Deviation from ideal mental health definition
= definition
+ves and -ves

Answer 28

Anything which deviates from ideal health is abnormal
ideal mental health should include
= +ve view of yourself
= capable of personal growth
= accurate view of reality
= resistant to stress + adapt to environment

+ useful to have a set of criteria against which to judge whether someone is functioning well or not

• subjective as peoples opinions may differ on whether someone is functioning adequality or not

Question 29

Describe ICD-10

Answer 29

ICD-10 covers all health disorders not just mental disorders

Produced by World Health Organisation and is used internationally, including UK

Chapter 5, Section F of ICD-10 is specifically for mental disorders

Groups disorders into categories and outlines symptoms for each disorder eg. given ICD-10 consisting of letter F followed by 3 digits e.g F20 is schizophrenia

Question 30

Describe DSM-5

Answer 30

Manual used to diagnose mental disorders

Groups mental disorders into ‘famlies’

Eg. anorexia, binge-eating disorder are all grouped under eating disorders

Question 31

Comparing ICD-10 and DSM-5

Answer 31

Similarites
= Both can be used to classify mental disorders
= Both group disorders into categories eg. eating disorders
= Both criteria are based on what medical experts believe are symptoms for specific mental disorder

Differences
= ICD-10 looks at physical ilnesses as well as mental disorders but DSM-5 only classifies mental disorders
= ICD-10 is written by World Health Organisation whereas DSM-5 is written by American Psychiatric Association
= ICD-10 views Asperger’s disorder as distinct from autism. DSM-5 does isn’t distinct and classified as Autistic Spectrum Disorder

Question 32

Strengths of classification systems

Answer 32

+ helps establish a reliable way to categorise and diagnose behaviours

+ helps to direct the most appropriate treatment for the individual

+ diagnostic systems have been adapted and changed to make diagnosis as reliable and accurate as possible e.g.. reducing cultural bias

+ interrater reliability if more than one clinician gives same diagnosis

Question 33

Weakness of classification systems

Answer 33

• highly subjective (diagnosis can change from one clinician to the next) so low validity
• problems with self-reporting their symptoms
  individuals may not perceive their behaviour as abnormal, report those seen as socially desirable, or lie
• significant overlap between disorders eg. bipolar and schizophrenia can feature delusions + disordered actions , anxiety common within depression (reducing validity)

Question 34

Outline one way in which psychotic disorder can be categorised [5]

Answer 34

ICD-10 is a classification system that can be used to diagnose a psychotic disorder (1), Chapter5, Section F specifically for mental disorders (1)

It groups disorders into categories and outlines symptoms for each disorder (1)

For schizophrenia, it would be grouped under psychotic disorders under F20 (1)

ICD-10 lists positive symptoms for schizophrenia eg. hallucinations and delusions and negative symptoms as speech poverty and avolition (1)

ICD-10 lists cognitive deficits associated with schizophrenia eg, disorganised though or speech (1)

Question 35

Characteristics of one affective disorder : Depression

• affective disorders
• prevalence
• key symptoms ICD-10

Answer 35

Affective disorder are referred to as ‘mood disorders’ as they affect a person’s emotional state. An example is depression.

Prevalence
= About 4.5% of population suffer
= Most common age of onset of depression is 20-30 yrs old

Key Symptoms
ICD-10 requires presence of at least two

+ low mood - depressed mood most of the day, nearly everyday
+ loss of interest and pleasure - in all activities, most of day, nearly everyday
+ reduced energy levels
+ changes in sleep patterns + appetite

Mild = 2 of key symptoms
Moderate = 4 or more symptoms
Severe = 7 or more of symptoms

Question 36

Characteristics of one psychotic disorder : schizophrenia

• psychotic disorder
• prevalence
• ICD-10 Key Symptom’s

Answer 36

Psychotic disorder are characterised by abnormal perceptions and thinking

Prevalence
= Rate of diagnosis higher in working class people than middle class
= Rate of diagnosis higher in countryside
= The average age of onset is 18 for men, 25 for women, 25% never recover

Key Symptoms

Positive
= hallucinations (perceiving things that aren’t there eg. hearing voices)
= delusions ( believing things that aren’t true eg. being plotted against, paranoid delusion, or your superman, delusion of grandeur)

Negative
= avolition (reduced motivation)
= alogia (speech poverty)
= cognitive deficits (disorganised thought or speech insertion - believing thoughts are being put in your head)
= flattened emotions (lose of emotions)

ICD-10 states there needs to be at least one clear cut symptom for a period of one month

Paranoid schizophrenia = powerful delusions and hallucinations

Hebephrenic schizophrenia = mainly negative symptoms

Question 37

Characteristics of one anxiety disorder : specific phobias

• anxiety disorder
• prevalence
• Key symptoms ICD-10

Answer 37

Anxiety disorder are characterised by feelings of overwhelming anxiety of fear
Specific phobia = involve irrational /excessive fear of an object or situation

Prevalence
= 9% of population have a specific phobia
= Generally appear in early childhood
= More than twice as many women as men have specific phobias

Key Symptoms
= pounding heart, sweating, trembling, nausea
= significant emotional distress due to the avoidance or the anxiety symptoms,
=a recognition that these are excessive
= avoidance of the object/situation

Question 38

Describe the characteristics of an affective disorder in a way that could be included on the NHS website [5]

Answer 38

One affective disorder is depression.

The NHS website would need to describe the symptoms of depression in every day language that the public understands rather than using psychological terminology

They would refer to low mood as feeling sad

It would also need to give suggestions about what to do next eg. visiting GP and possible treatments eg. CBT

It would need to distinguish differences between mild depression (some impact on daily life) moderate depression (significant impact) and severe depression (impossible to get through daily life)

Question 39

Assess one difficulty a clinical psychologist could experience in trying to confirm that her patient is experiencing a psychotic disorder [6]

= why it would be difficult
= how they could improve it

Answer 39

psychotic disorder eg. schizophrenia is reliance on self report

if suffering from delusions, they may believe that Lena is working against them so may not report certain symptoms out of fear for their safety

if patient has poverty of speech or disorganised spec they might not report symptoms effectively > incorrect diagnosis

Lena could go through checklist of symptoms slowly so patient can report everything
Lena can make patient feel safe by explaining what diagnosis might lead to

Question 40

Compare characteristics of affective disorder with psychotic disorder [8]

Answer 40

PARA 1
BOTH CAN LEAD TO LOSS OF REALITY
= schizophrenia have paranoid thoughts (delusions)
= depression have irrational thoughts eg. no one likes them as one person ignores them

SCHIZOPHRENIA HAS GREATER LOSS OF REALITY
= they perceive things that aren’t there (hallucinations) and people with depression don’t
—————————————————————
PARA 2
BOTH LEAD TO LOSS OF INTEREST AND LOWER ENERGY LEVELS
= schizophrenia with negative symptoms show lack of interest of themselves eg. not brushing hair
= depression show lack of interest in things they once enjoyed

HOWEVER
= depression lack of interest is related to low mood, whereas lack of interest in schizophrenics is linked to changes in perception

Question 41

Compare characteristics of an affective disorder with anxiety disorder

Answer 41

BOTH HAVE UNREALSTIC THOUGHTS AND LOSS OF REALITY
= depression have irrational thoughts eg. no one likes them as one person ignores them
= specific phobias have irrational thoughts eg. phobia of spiders, they can kill them

BOTH LIMIT ACTIVITIES
= depression might stop going out with friends
= specific phobias stop going on planes if phobia of flying
—————————————————————
BOTH MORE LIKELY TO AFFECT FEMALES
= depression 3x more likely
= specific phobia 2x more likely
= however this could be due to social stigma or masculinity and not getting help

Question 42

Compare characteristics of anxiety disorder with psychotic disorder

Answer 42

LEAD TO LOSS OF REALITY + UNREALISTIC THOUGHTS
= specific phobia have irrational thoughts of object/situation
= schizophrenia have paranoid thoughts eg. being plotted against

SCHIZOPHRENIA HAVE GREATER LOSS OF REALITY
= experience hallucinations too
—————————————————————
SPECIFIC PHOBIAS MORE LIEKLY TO AFFECT FEMALES, SCHIZOPHRENIA MORE LIKELY TO AFFECT MEN
= specific phobias 2x more likely for females
= schizophrenia males more likely to require hospitalisation

Question 43

Socially sensitive research in relation to historical context of mental health

Answer 43

= diagnosis of disorders have consequences for individuals, families and wider community

= Rosenhan showing how it lacks validity so possible wrong diagnosis so don’t take treatment given to them

= Rosenhan led to positive implications eg. DSM 5 and ICD-10 consistently being improved

= definitions of abnormality as social norms definition could lead to prejudice. Groups can be labelled abnormal due to different lifestyles

Question 44

Free will/determinism debate in relation to historical context of mental health

Answer 44

DETERMINIST
= historical views that rely on biological factors eg. Hippocrates and somatogenic approaches (biological determinism)

= rosenhan ‘stickiness of labels’ show how we are treated is determined by our mental ilness

FREE WILL
= psychogenic approach suggests through psychoanalysis we can overcome unconscious conflicts + exert free will

= definitions of abnormality - failure to function adequately suggests people chose to function normally in everyday life

Question 45

Nature/Nurture debate in relation to historical context of mental health

Answer 45

Historical explanations of mental health support both nature and nurture
>Somatogenic + Hippocrates support nature
> Psychogenic + Supernatural support nurture

Definitions of abnormality support nurture and nature
> deviation from social norms shows we are abnormal due to societal beliefs in enviro which vary culture to culture
> statistical infrequency shows if we are 2 standard deviations away from average on characteristics we are born with eg. IQ

Rosenhan supports nurture
= country we live in affects diagnosis, treatment and the way people with mental illness is perceived
= hospitals treat them was part of culture in psychiatric hospitals in US

Question 46

Reductionism/holism debate in relation to mental health

Answer 46

Deviation from social norms reductionist
> statistical infrequency only looks at one factor determining if its abnormal or not
> 5% of population have, misses wider picture + doesn’t take into account if they need help
> deviation from social norms only looks at how social norms affect abnormal behaviour

Classification systems more holistic
> DSM uses range of criteria to diagnose mental disorders
> considers persons background and how cultural issues can affect diagnosis
> schizophrenia take into account age, background and culture
> however, list of criteria is still reductionist

Rosenhan is holistic
> qualitative descriptions of experiences covered wide range of factors eg diagnosis on release, stickiness of labels, powerlessness and depersonalisation
> quantitative in terms of contact time and how long they were kept in hospital

Question 47

Structure for debates questions

Answer 47

PARA 1 - historical views of mental health
PARA 2 - definitions of abnormality
PARA 3 - Rosenhan