HISTORICAL CONTEXT OF MENTAL HEALTH Flashcards
6500 BC
Due to witchcraft, religion and demonic possession
Ancient Egyptians and early Chinese believed it was punishment for wrong doings
Trepanning used up until WW1 to treat migraines, epilepsy and insanity- drill into skull to relieve pressure
800-7000 BC
Humoral Theory
Hippocrates believed mental illness was caused by physiology
Human body composed of four bodily fluids:
-blood, phlegm, black bile, yellow bile (produce personality)
Mental illness occurred if one humour was in excess
Treatment:
-diet/exercise, bloodletting, laxatives
1247-1500s
Asylums
Late 13th century to 16th mental hospital established
Meant to be a safe place, intact dehumanising
Places where new treatments were tested
-hydrotherapy (sprayed with water to stimulate them)
-convulsion therapy (stimulates senses)
A moral view
Late 18th century ‘moral treatment’ advised good nutrition, hygiene and a productive day
Px allowed out of their rooms
Psychogenic (talking therapy)
Mental illness seen as psychological rather than physiological or spiritual
Freud- talking therapy
Treatment focussed on psychoanalysis
Mid-late 1900s
Medical view
Caused by genes, neurotransmitters, hormones, etc
Mental illnesses have external symptoms
Treated with drugs, electroconvulsive therapy
Explain deviation from social norms as an abnormality
Standards of acceptable behaviour that are set by the social group and adhere to those norms but if you deviate from them you are abnormal
Strengths of deviation of social norms
Distinguish between desirable and undesirable behaviour, society determines what is desirable
Deviance is related to context and degree
Weaknesses of deviation from social norms
Cultural relativism- social norms vary in culture
Explain statistical infrequency
Anybody who is above or below the norm/average will be classed as abnormal (bell curve, standard deviation greater than 2)
Strengths of statistical infrequency
Clinical diagnosis- objective, can be compared against statistical norms
Weaknesses of statistical infrequency
Cut off points may be subjective
Hard to distinguish between desirable and undesirable behaviour
Factors of categorising mental disorders
Classification system
List of symptoms a Px needs to exhibit for a certain period of time
Two types of diagnostic tool- DSM-5 and ICD-10
Factors of the DSM-5
2013
Fifth edition= latest scientific thinking
Allows clinicians to make accurate consistent diagnosis
Based on Western culture
What are the sections of the DSM-5
How manual should be used
20 categories of disorders |(e.g. psychotic and anxiety), listed in lifespan order, may have spectrums or severity
Assessment tools and discussion of cultural concepts or disorders to reduce cultural bias
Factors of the ICD-11 (International classification of diseases)
Identifies trends and statistics relating to injuries, sickness and death
Each disease has a description of main features and any important associated features
Indicates how each feature and balance required between each different type needed to make accurate diagnosis
What are validity issues with using technology to diagnose mental disorders
Ford and Widgier
Does label given reflect an accurate measure of symptoms?
Ford and Widgier (1994) found that presenting same symptoms but changing gender results in diff diagnosis
Females- histrionic personality disorders
Males- anti-social disorders
Cheniaux (2009)- validity of mental disorder classification
2 psychiatrist’s independently diagnosed 100Px using both DSM and ICD
1- 26 diagnosed with Sz (DSM) and 44 (ICD)
2- 13 Sz (DSM) and 24 (ICD)
Poor criterion validity (whether similar measurements arrive at the same result)
Evidence for high inter-rater reliability
Anxiety and mood disorders- 362 outpatient
2 independent interviewers using anxiety interview using DSM-4
High levels between them
Disagreements- whether symptoms severe enough to meet criteria/gain a diagnosis
Hard to classify boundaries particularly regarding depression and anxiety
Aim of Rosenhan
Test the hypothesis that psychiatrists cannot reliably tell the difference between people who are sane and those who are insane
Sample and procedure Rosenhan
P observation
8 sane people (3F and 5M), acted as pseudo Px
-fake names, symptoms, etc
Px arranged appointments at hospital, complained they heard ‘thud, empty, hollow’
Once admitted, told to get out on their own, by convincing staff they were sane
Px were observers
Results from Rosenhan:
Diagnosis
Px were admitted and were eventually discharged with a diagnosis of Sz in remission
None of the pseudo Px were suspected by staff but some actual Px had suspicions
Results:
Distortion of behaviour
Note taking was recorded by nurses, implying it was part of the disorder
Waiting outside of cafe before lunch was interpreted as ‘oral-exquisite nature of the syndrome’
Lack of normal interaction
Doctors ignored requests about being discharged
Doctors and nurses spent 7 minutes per patient a day
Powerlessness (Rosenhan)
Medical records available to all staff- lack of privacy and personal hygiene monitored
Attitude to medication
2100 tablets administered in total 2 swallowed
Flushed down toilet, bound tablets from real Px
As long as cooperative, behaviour went unnoticed
Conclusions from Rosenhans
Doctors cannot reliably tell the difference between sane and insane, failure or identifying illness may be worse than classifying a healthy person as sick
Expectations that people are ill due to context, therefore suggesting diagnosis is invalid as it relies on situation not behaviour
Stickiness of psychodiagnostic label- once pseudo Px had been labelled there was nothing they could do
Aim for study 2 by Rosenhan
Once aware of participating in study, the doctors and nurses would be under caution when diagnosing pseudo Px
Therefore, whether the Ps would make type 2 errors- missing diagnosis when a mental disorder exists
Sample and procedure for exp 2
Staff asked to rate on a 10 point scale each new patient as to the likelihood for them being a pseudo patient
Results from exp 2 (pseudo)
One member of staff- 41
One psychiatrist- 23
Psychiatrist and member of staff- 19
Strength of Rosenhan
Field exp- eco validity (psychiatric hospital)
Long period of time
Exp 2- inter rater reliability
Large sample- 193, exp 2
Weaknesses of Rosenhan
Not a balanced sample- 3 females, 5 males, not representative
Exp 2- one hospital used- cannot compare
What are behavioural characteristics/symptoms of specific phobias
Avoidance of specific object/situation
When they can’t avoid it they panic- fight or flight
Emotional symptoms of phobias
Excessive and unreasonable fear
Triggered by specific object
Cognitive symptoms of phobias
Selective attention
Causes person to be fixate on the object they fear due to irrational beliefs about potential danger
What is a psychotic disorder
Characterised by abnormal perception and thinking
Px lose touch with reality, meaning they are not aware of their mental state
E.g. schizophrenia
Positive symptoms of schizophrenia
Presence of symptoms Hallucinations (hear/smell things) Auditory Visual Tactile- feeling of movement on the body
Negative symptoms of Sz
Absence/lack of normal mental functioning
Trouble with speech
Withdrawal- no longer making plans
Lack of pleasure
Cognitive deficits of Sz
How well the brain learns, stores + uses info
Hard time with working mem
E.g. may not keep track of different things at the same time
Trouble paying attention/organising
Example of an affective disorder
Depression
Behavioural characteristics of major depression
Changes in appetite/weight
Moving slower than usual
Trouble interacting with people/avoidance
Emotional characteristics of major depression
Low self-esteem
Thoughts of death or suicide
Isolating yourself
Cognitive characteristics of major depression
Harder to problem solve
Poor memory
Cant control impulses/concentration
Indecisive
Task- Asses one difficulty that Lena could experience in trying to confirm that her Px is experiencing a psychotic disorder
STRUCTURE
Understanding- abnormal thinking and perception, Px lose touch with reality, not aware of mental state
Difficulty- overlap of symptoms can be problematic, hard to diagnose accurately- e.g. withdrawal= depression and Sz
How to overcome- further tests, second opinion
Define an affective disorder
Symptoms for uni-polar disorder can come and go in cycles but during a depressive episode symptoms cane severe
What is an anxiety disorder
E.g. phobias
Introduce fight or flight response
