IMH Topic 1- Historical Conext Of MH Flashcards
What are the 4 historical views of mental illness
Demonic possession, humourism, animalism, moral treatment
Discuss demonic possession (supernatural)
Idea that everyone has a soul. In pre modern societies this was an explanation for madness and was that evil spirits had taken possession of someone and controls their behaviour. May be possessed by diff kinds of spirits (ancestors, animals, gods, hero’s, victims). Enter through their own cunning, the work of an evil doer w magical powers or lack of faith. Evidence: skulls of Palaeolithic cave dwellers have holes (trephines) as have been chipped by stone instruments to give exit for demons/spirits in skull
Discuss humourism (Hippocrates 460-377BC) somatogenic explanation
Said mental health depended on a balance of the 4 humours (bodily fluids). Too much blood means changeable temperament, excess of black bile is reason for melancholia. Too much yellow bile causes irritability/anxiousness and too much phlegm causes a person to be sluggish and dull. Treatments were to re balance e.g. depression threatened by bloodletting, laxatives, diets and excess blood used leeches.
Discuss animalism 18th century somatogenic explanation
St Mary’s of Bethlehem /bedlam in London where insane patients were chained to walls/kept on long leashes. Us first hospital Pennsylvania hospital in 1756 set aside a section for lunatics at urging of Ben Franklin. Kept in cellar, scalps were shaved and blistered, bled to unconsciousness, purged until alimentary canal produces mucus, also were whipped. Believed madness resulted from animals and has lost reason which is what separates human from beast so behaviour was disordered and wild. To restore reason, fear was used but end of 18 century p, protestors grew over conditions
Discuss moral treatment
Phillippe pinel born in France became a doctor and wrote articles about mental disorders. 1792, appointed chief physician of bicêtre asylum where he petitioned to revolutionary committee to remove chains and allow patients to exercise in open air. When these priced affective he changed more conditions (stop blood letting, purging and abuse). Rejected notion illness die to possession and said caused by psychological/social stress or injury. Argued for humane treatment including friendly interactions between doc and patient, created case histories and records.
What are the 4 ways of defining abnormality created by rosenhan and seligman
Statistical infrequency, failure to function adequately, deviation from social norms, deviation from ideal mental health
Discuss statistical infrequency and the problems with this
Any behaviour shown less often than normal for society. in 2012 3.45% of uk pop have schizophrenia so is an abnormality. Depression in 7.38% but still abnormal. Problems: just having abnormal behaviour doesn’t mean psych disorder e.g. highly gifted in sport or intelligence are abnormal
Discuss failure to function and problems with this
If a person is unable to live a normal life like hold down a job, maintain relationships, look after themselves, interact in society. Problems: abnormal doesn’t just mean mental illness as someone’s may have a lack of education so can’t get job, lack of money may mean can’t look after themselves, failure to function could be result of ilnesss like addiction
Discuss deviation from social norms and the problems with this
Every society had social norms that are maintained by laws, guidelines, and societal pressure e.g. illegal to take class A drugs but guidelines about how much to drink, society pressures people to work and frowns upon talking to self so if don’t follow these- seen as abnormal and can be a result of things like ocd (checking things, rituals). Problems: if someone’s doesn’t follow all Norms, doesn’t mean disorder may talk to self on occasion and is culturally specific so each has different but no disorder in all countries.
Discuss deviation from ideal mental health and the problems with this
Psychologists have criteria that represents ideal mental health ( feeling positive about self, self discipline, perception of reality, social relationships. Extended by r&s to include suffering maladaptiveness (not fitting in W society), unconventional behaviour, irrationality in behaviour, unpredictable/loss of control, observer discomfort, violation of moral standards. Normal people may display one of these but not more. Johoda had common themes of positive self image, growth, independence, accurate perception, cope with problems and relationships. Problems: can be vague and difficult to quantify and many don’t exhibit all criteria at once
Background to rosenhan- categorising mental disorders the DSM-5
Developed by kraeplin- published 1st book of psychiatry in 1883 and said groups of symptoms occur together often enough to be disease with physical cause. Categories: dementia praecox (schizo) and manic depressive psychosis. Dsm1 1952, most recent dsm5 by American psychiatric association in 2013, text revision in 2022, other countries have their own e.g. China international classification of diseases both physical and mental. 1983 mental health act had 3 categories mental illness, personality disorder and mental impairment. Dsm5 organised on developmental and lifespan considerations and has 2 types internalising disorders eg. Depression and externalising e.g. substance abuse. Has 22 categories examples neurodevelopmental, disorders (adhd, asd, Tourette’s), neurocognitive (phobias, social phobia, panic disorder), obsessive and compulsive&related (hoardings hair pulling, skin picking). Also included are gender related diagnostic issues (some more common in each bender), culture related diagnostic issues as norms differ. Co morbidity (more than one at same time), prevalence and diagnostic criteria to diagnosis symptoms
Key research- rosenhan on being sane in insane places 1973 PART ONE (study one and experiment within)
Aim: to see if mental hospitals in the early 70s could tell the sane from the insane. Study 1 involved 8 sane people phoning up for appt at sample:12 diff mental hospitals across 5 states . When arrived, all reported same symptoms )hearing an unfamiliar voice of same sex sating empty, hollow and thud) gave false names. Once admitted stopped any symptoms and took part in regular ward actives p, recorded noted about staff and patients. All admitted (1 manic depressive psychosis and all others schizo diagnosis p). Remedied for 7-52 days (avg.19). Discharged w schizo in remission. Insanity not detected by staff but 35/118 patients voiced suspicions (you’re not crazy, you’re a journalist). Normal behaviour misinterpreted (note taking seen as symptom, Quinn for meals seen as oral acquisitive behaviour). Records could be read by anyone, staff brutal to patients but stopped if another staff came. Staff spent 11.3% of shifts outside the cage and spent 6.8m/day w patients. Experiment 1: in 4 hospitals, approached staff with simple request (pardon me, could you tell me when I will be presented at the staff meeting), comparison done at Stanford with young fences approaching faculty W question (could you direct me to encina hall for par example) comparison at uni medical centre W female saying amongst qs I’m looking for psychiatrist or an internist
Key research rosenhan PART 2 starting with results from experiment 1
Moves on head averted was 71% psychiatrists, 88% nurses/attendants in psych hospital. 0 for uni and medical centres. Stops and talks was 4% psychiatrists, 0.5%nursers in psych hospital. 100% for uni and looking for internist @ medical Centre but 78% looking for psychiatrist @medical centre. Study 2: a teaching/research hospital aware of the first study was informed that during the next 3 months one or more pseudo patients would attempt to be admitted to the hospital. Each staff asked to rate 1-10 each new patient the likelihood of being pseudo but to treat everyone as a real patient so no one missed treatment. 0 pseudo patients were admitted but 19/193 patients judged as fake by one psychiatrist and one other staff member. (41 staff, 23 psych). Conc: mental hospitals is early 70s not good at making valid diagnosis or reliable as not all diagnosis give, view all behaviours as reflecting diagnosis (reflecting the stickiness of labels), patients treated with disrespect (come on you mother f-er out of bed)
How could rosenhans research be improved
Collecting data from larger no. Hospitals or ones beyond us. Patients present more than one set of symptoms. Formally testing whether any tendencies towards inaccurate diagnosis based on age, gender , ethnicity
How did rosenhan explain behaviour of abusive staff
explained by staff being in a position of power and not seeing the patients as equals. why the abuse was ended when another member of staff appeared, could be other members of staff will have been seen as credible witnesses, while (owing to their diagnosis of a mental illness) patients would not have been. characteristics of the practitioners which would make them likely to abuse, eg power; characteristics of the patients likely to make them victims eg label; and consequences eg verbal abuse. This would also be the case for behaviour stopping, if the characteristics of the co-workers are identified eg likely to be believed.
