Issues in mental health: Topic One Flashcards
What is topic one?
The historical context of mental health
What are the 3 historical views of mental illness?
Animism, humourism and animalism
What is the general belief of animism?
That everyone and everything has a soul and mental illness was as a result of evil spirits taking possession of an individual and controlling their behaviour
Some skulls of Paleolithic cave dwellers have been found with what?
Characteristic holes (trephines/trepanes) which were chipped out by stone instruments
What was the purpose of trepanning?
To provide an exit for the evil spirit
Who came up with the theory of humourism?
Hippocrates
What did Hippocrates identify mental illness as?
A scientific phenomenon
What did Hippocrates believe in terms of mental illness?
That ‘madness’ resulted from an imbalance of the four humours and could therefore be balanced to cure the person
What were the 4 humours?
Blood, phlegm, yellow bile and black bile
What did Hippocrates believe that depression (melancholia) was a result of?
Too much black bile
What were some treatments used to rebalance the four humours?
Bloodletting, blistering and laxatives
What was the main principle of animalism?
The idea to treat the mentally ill like animals
What was the main reasoning for treating the ‘insane’ like animals?
Because they believed that madness caused a lack of capacity of ‘reason’ which they felt distinguished humans from beasts
As a result of disordered and wild behaviour, what was the first part of treatment? (animalism)
To restore reason by keeping patients locked up, chained and possibly whipped
Why were the mentally ill treated via bleeding, blistering and vomiting? (animalism)
As it was believed patients didn’t have sensitivities, like animals
Who suggested the 4 ways of defining abnormality?
Rosenhan and Seligman
What are the 4 ways to define abnormality?
Statistical infrequency, failure to function adequately, deviation from social norms and deviation from ideal mental health
What is the general idea of statistical infrequency?
The idea that if something is outside the statistical ‘norm’ then it would be termed abnormal
Give an example of statistical infrequency
Schizophrenia - only affects 3.5% of the population and is therefore statistically rare/abnormal
What is failure to function adequately?
Whereby someone is unable to meet typical obligations and cannot live a ‘normal’ life they are seen as not functioning adequately
Give some examples of things that would be considered a failure to function adequately
Not going to work, not maintaining relationships or not looking after one’s health
What are social norms and therefore what can be abnormal behaviour be seen as?
Social norms are expected or approved ways of behaving so abnormal behaviour may be seen as that which deviates from social norms
What is ‘ideal mental health’?
Being positive about yourself
Able to cope independently
Accurate perception of reality and being able to cope with demands
Positive social interactions
What is deviation from ideal mental health?
When a person does multiple ‘abnormal’ things in terms of mental health
Give some examples of behaviour which would show deviation from ideal mental health
Suffering, maladaptiveness, unconventional behaviour, irrationality, unpredictability and violation of moral standards
How do we categorise mental disorders?
Using the DSM-5
Who produces the DSM?
The American Psychiatric association
What does DSM stand for?
Diagnostic and statistical manual of mental disorders
Where else are mental disorders categorised other than the DSM?
The international classification of disease (ICD-10)
How many categories of mental disorder are in DSM-5 and give some examples
22 categories including, depressive, anxiety, feeding and eating, sleep-wake disorders and sexual dysfunction disorder
How does the DSM cluster disorders?
Into internalising disorders and externalising disorders
Give an example of an internalising disorder
Depression
Give an example of an externalising disorder
Impulsive disorder
What other things does the DSM include information on?
Gender and culture related diagnostic issues, comorbidity (when disorders occur together), prevalence (frequency of issue within age groups) and diagnostic criteria
What is the key research for topic 1?
Rosenhan - on being sane in insane places
What was study 1 of Rosenhan’s research?
Can psychiatric hospitals detect sanity?
How many sane people phoned up for an appointment at how many different mental hospitals?
8 people called 12 different hospitals
When the pseudopatients arrived at admissions what did they all report?
The same symptoms of hearing an unfamiliar voice of the same sex saying ‘empty’, ‘hollow’, ‘thud’
Once the pseudopatients were admitted what did they stop doing?
They stopped simulating any symptoms and took part in regular ward activities
What diagnoses were the pseudopatients given?
11 were given a diagnosis of schizophrenia and 1 manic-depressive psychosis
How long, on average did the pseudopatients remain in hospital?
19 days
Upon discharge, what diagnosis were the pseudopatients given?
Schizophrenia ‘in remission’
How many patients at the hospital had suspicions about the pseudopatients?
35 out of 118
Give some qualitative data from the patients about the pseudopatients?
‘You’re not crazy’, ‘You’re a journalist or professor’, ‘You’re checking up on the hospital’
Outline which normal behaviours were seen as a symptom of their disorder
Note-taking and queuing up for lunch was described as displaying oral acquisitive behaviour that might be expected of someone with schizophrenia
Who had access to patients records?
Anyone
What was the total time a patient spent with psychologists, psychiatrists etc in a day?
6.8 minutes
Describe the experiment in study 1
The pseudopatients would approach a member of staff with a simple polite request asking when they would be presented at the staff meeting
What did pseudopatients record from the experiment in study 1?
They recorded how staff responded to the request (i.e. if they moved on with head averted, made eye contact, paused and chatted or stopped and talked)
At how many of the hospitals did the pseudopatients conduct the experiment?
4
What was Rosenhan’s second study?
Can psychiatric hospitals detect insanity?
What were the psychiatric hospital told in the second study?
They were informed that during the next three months, one or more pseudopatients would attempt to be admitted to the hospital
In reality, how many pseudopatients did Rosenhan send to the hospital?
0
How many patients were confidently judged as pseudopatients by one psychiatrist and one other staff member?
19 out of 193
Summarise Rosenhan’s conclusions
Mental hospitals made inaccurate and unreliable diagnoses in the 1970s and treated patients with profound language/disrespect
What is an affective disorder?
A disorder that affects mood
Give an example of an affective disorder
Depression
What does the DSM-5 say about the diagnosis of depression?
That 5 or more symptoms must be present during the same 2 week period including either symptom 1 or 2 for a diagnosis of depression to be given
What is symptom 1 of depression?
Depressed mood most of the day, nearly every day
What is symptom 2 of depression?
Diminished interest or pleasure in all or most activities most of the day, nearly every day
Give 3 other symptoms of depression
Insomnia or excessive sleep (hypersonic) nearly every day, Fatigue or loss of energy, Recurrent thoughts of death or suicide
What is a psychotic disorder?
A disorder which causes someone to lose touch with reality (e.g. through hallucinations or delusions)
Give an example of a psychotic disorder
Schizophrenia
What are symptoms of psychotic disorders said to be?
Either positive or negative
What does a diagnosis of schizophrenia require?
Major symptoms need to be persistent with at least 2 positive symptoms for at least one month
Give some examples of positive symptoms of schizophrenia
Hallucinations (perceptual disturbances e.g. voices), Delusions (false beliefs)/Paranoid delusions/delusions of grandeur (believing you’re famous) or disordered thinking (unable to concentrate and sort thoughts)
Give some examples of negative symptoms of schizophrenia
Affective problems (reduction in range and intensity of emotion e.g. laughing at an inappropriate time), Poverty of speech (reduction in speech fluency) and reduced motivation
Give an example of an anxiety disorder
Phobias
What is a phobia?
An extreme or excessive fear or something with a physiological response
What are the 3 types of phobia?
Agoraphobia, specific phobia or social phobia
Describe agoraphobia
Fear of open spaces - typically the fear of not being able to escape. In extreme cases, agoraphobics become ‘prisoners’ in their own homes
Describe social phobia
Intense and excessive fear of being in a situation in which one is exposed to possible scrutiny by others. Also, a fear of embarrassing oneself
Describe specific phobia
A fear of a specific thing or situation (e.g. spiders)
What are the strengths of the process of diagnosis?
DSM has a comprehensive list of symptoms and disorders, so can easily diagnose with the help of this
What is a weakness of the process of diagnosis?
Reliant on a patient being honest about their issues and they could therefore exaggerate as they rely on self report
