Historical context of mental health Flashcards
What was believed about mental health in Ancient times?
- Demonic possession
- Caused by Gods if you had done wrong
- Trepenation-dirilling of the skull to let spirits out.
What was believed about mental health in the Middle Ages?
- as a result of demons and witchcraft
- imbalance of 4 body fluids
- blood letting and purging
- exorcisms
What was believed about mental health in the 20th century?
- biochemistry, cognitive, humanistic, behaviourism
- Psychotherapy/Psychoanalysis
- ECT
- Drugs
What was believed about mental health in the 21st century?
- genetic,biological,psychologicak,medical
- Medication
- Wellness
- CBT
What was believed about mental health between 16th to 19th century?
- Asylums such as Bedlam
- Asylums seen like zoos
- imprisonment/hospitalisation
- protect society from ill
- mixed attitudes between people
Deviation from social norms
Not abiding with social norms accepted/expected by society.
e.g. OCD excessively checking
However some symptoms such as tiredness and stress are not socially unacceptable.
Deviation from ideal mental health
You are abnormal if you don’t fit the criteria of good mental health.
e. g. ‘Good’ is categorised by:
- growth,development and self actualisation
- true perception of reality
- postitive attitude towards self
However there are opinions of what is normal- everyone has poor perception of self.
Failure to function adequately
Unable to live a normal life: hold down a job, maintain relationships, look after themselves. This means the disorder is affecting daily life.
e.g. Depression unable to hold down a job. Addiction unable to maintain self care. Autism can’t maintain relationships.
However may be another cause such as personality.
Statistical Infrequency
Not average compared to the rest of the population. (normal distribution curve)
e.g. Multiple personality disorder would be abnormal under this definition as less than 1% of population have it.
However some are more common such as depression and anxiety so not seen an abnormal.
ICD 10
2016
- developed by WHO
- og was a medical model for morbidity and 8th edition developed a mental health chapter
- applied and research based form 23 WHO countries
- diagnostic section: disorders grouped by common causes/ symptoms
- clinicians need to identify type then variation
- can be vague but trusts experienced doctors an clinical specialists.
ICD 11
2018
- updated interactive web platform
- 10 blocks of disorders now extended to 24
- behavioural syndrome associated with psychical factors will each get own block (eating disorders)
DSM IV
1994
- developed by American Psychiatric Association
- by Americans for Americans
- funded by pharmaceutical associations (clinical research, ones that require drugs)
- multi-axil system of 5 broad groups
DSM 5
2013
- all inclusive, considering all of a person’s functioning at once
- has combined Autism with AS
- changed how childhood disorders are defined(removal of childhood bipolar disorder with DMDD)
Anxiety Disorder definition and examples
Give a continuous feeling of fear ad anxiety which is disabling and can impose on daily functioning.
e.g. panic attacks, hobbies, PTSD, anxiety OCD
Anxiety Disorder Phobia DSM & ICD
Phobia-persistent fear of a particular objet or situation.
ICD 10-symptoms must be primary manifestations of anxiety. Phobia is avoided.
DSM 4/5-fear provokes an immediate response actively avoided out of proportion to actual danger. Has to last 6 months under 18. Disturbance does not fit into any other category.
Affective Disorder definition and examples
Affects your mood and behaviour so that you can’t function adequately.
e.g. depression, manic disorder, bipolar
Affective Disorder Depression DSM & ICD
ICD10- depressed mood, loss of interest, increased fatigue. Minimum 2 weeks. Display 2/3 of the typical symptoms and 3/4 of atypical symptoms. Those moderate severe will have difficulty in continuing with social, work and domestic activities.
DSM 4/5-mist display 5 symptoms for over 2 weeks. not attributed to any other cause and causes significant distress.
Psychotic Disorder definition and examples
Causes a loss of contact with reality. Causes a person to have hallucinations leading to confusion and disorientation.
e.g.schizophrenia, paraphrenia
Psychotic Disorder Schizophrenia DSM & ICD
ICD 10-2 or more symptoms for 1 month. Positive symptoms: hallucinations, delusions. Negative symptoms: flat emotions. Cognitive deficits:disorganised thoughts/speech. 9 sub-types: paranoid (+), catatonic, disorganised, hebephrenic (-).
DSM 5- 2 or more symptoms for 1 month. For more than 6months then residual too. 5 main symptoms: delusions, hallucinations, disorganised speech/behaviours, social and occupational dysfunction.
Rosenhan (1973)
Aim pt1
To test the reliability and validity of diagnosis of sanity by psychiatrists when presented with sans people, using the DSM2.
Rosenhan (1973)
Sample
Method (3parts)
Patients and staff at 12 psychiatric hospitals across 5 states.
- Field experiment
- pt1 used participant observation
- pt2 used a questionnaire
Rosenhan (1973)
pt1 procedure
- 8 pseudo patients telephoned the hospital saying that they had heard noises of the opposite sex saying things such as ‘empty’, ‘hollow’ and ‘thud’.
- 7 admitted with schizophrenia and the other with bipolar. This shows it is fairly reliable but not valid as they were all sane.
- little evidence to support that they had these disorders so the psychiatrists were seen as overcautious
- acted normally in hospital, said they no longer had symptoms and had to prove their sanity to the staff.
- many of the true patients suspected that the pseudo patients weren’t real.
Rosenhan (1973)
pt1 data gathering
- took notebooks and noted down the conditions of the hospital, staff and patients
- qualitative data from observations on the abuse from some staff towards patients
- quantitative data was collected by timing the length of interactions between staff and patients
Rosenhan (1973)
pt1 results
- pseudo patients seems as abnormal when queuing for lunch early and was seen as pathological behaviour
- an account given about childhood and relationship details was described as a schizophrenic reaction
- psychiatrists resounded to patients 4% of the 185 times
- nurses responded 0.5% of the 1283 attempts
- were is hospital average 19 days which ranged from 7-52
- released with schizophrenia of remission
Rosenhan (1973)
pt1 conclusions
- type2 error occurred (really type1) due to incorrect diagnosis
- ‘stickiness’ of the mental illness as still had ‘remission’
- any normal behaviour was classed as a reaction
- DSM2 had very low validity
Rosenhan (1973)
Aim pt2
To see if staff would be under cautious having knowing about the miss diagnosis in the first experiment
Rosenhan (1973)
Sample pt2
Staff at one psychiatric hospital who had been informed of the 1st lot of results and were disbelieving of the poor diagnosis.
Rosenhan (1973)
pt2 method
- Rosenhan said he would send in pseudo patients for staff to depict who was genuine. Planned to last 3 months.
- didn’t send anyone
- rated patients on a 10-point scale with 1 being that they had high confidence that the individual was a pseudo patient.
Rosenhan (1973)
pt2 results
Out of the 193 patients admitted at the time, those thought to be pseudo patients were:
- 41 by at least one staff member
- 23 by one psychiatrist
Rosenhan (1973)
pt2 Conclusions
- Rosenhan said it was a Type 1 error as the hospital failed to diagnose ill patients properly (truly type 2)
- staff were under cautious with diagnosis which questions the validity and accuracy of the DSM 2.
