Lecture 1 - History & Background Flashcards
1
Q
Ancient Views and Treatment
A
- Historians examined bones, artwork and other remains.
- believed mh difficulties due to possession
- holes in skull thought to be evidence of trephination - removing spirits through drilling
- exorcism key treatment
2
Q
Greek & Roman views
A
- Hippocrates: illnesses had natural causes of physical problems. also emphasised importance of heredity/predispositions.
- e.g. injury to head = motor disorder
- classified mh into 3 categories: mania, melancholia & phrenitis
- illness = humor imbalance (mania excess yellow bile, melancholia excess black bile)
- Galen used treatments such as bloodletting & acknowledged role of psychological stressors in health.
3
Q
The rise of asylums
A
- appeared in late 1400s
- designed to be humane but overcrowded and underfunded = unsanitary & physical punishments.
- asylums set people back
4
Q
William Tuke & Harriet Martineau
A
- spearheaded asylum reform in UK
- led to development of the Lunacy Inquiry Act (1842) meaning asylums were to be inspected every 4 months
4
Q
Europe in the middle ages: rise of demonology
A
- as rome declined power of clergy inc: supernatural understandings of mh
- medieval times had church revived theories of possession
- only from renaissance did demonological views decrease due to scientific & cultural knowledge
5
Q
Philippe Pinel & Asylum Reform (1700s)
A
- chief physician - it was a morally right thing to provide treatment, food and support.
- move individuals to better rooms and access to fresh air.
- studied & classified mh symptoms using rm and observations of symptoms over time
- argued poor mh due to social, psychological & physiological factors together.
6
Q
somatogenic perspective of medication
A
- physical approaches to mh treatment relatively unsucccessful and accidentally discovered medications to improve QOL: e.g. chlorpromazine (antipsychotic) and tricylic antidepressants
- drug companies invest in marketing that mh conditons are common, treatable and physical
- marketing on thorazine centred on benefits but turned people into zombies
- led to rise of drugs
6
Q
Freud (psychogenic perspective)
A
- proposed mh conditions originate from the unconscious mind and early life exp.
- collision with somatogenic perspective: theories untestable
- treatments were for privileged people and out patients. first outpaint appointment was office-based psychoanalysis
6
Q
diagnostic categories
A
- we want targeted categories to diagnose
- want to know what symptoms categorise as, treatments to assist & prognosis
- valid, discrete entities demarcated by firm boudaries between one another and normality
6
Q
deinstitutionalisation (1870 - 1960)
A
- inc numbers admitted to asylums made humane practices harder to sustain in 1800s.
- newly developed sedatives used more & physical therapies e.g. shocks
- mh hospitals grew until mid 1950s. now there is a lack of beds and funding so inpatient treatment may be further away = cuts off social relationships
7
Q
Kraeplin (somatogenic perspective)
A
- father of modern psychiatry. developed documenting symptoms and led to classification.
- psychiatry = medical science informed by observation and empirical practices
- opposed inhumane practices and psychodynamic/philosophical approaches
- promoted neuropathological approach (co-discoverer of alzheimers)
8
Q
mh condition definition
A
- DSM5: ‘syndrome characterised by clinically signif disturbance in cognition, emotion regulation ot behaviour that reflects a dysfunction in the psychological, biological or developmental processes underlying functioning.
- md usually associated with distress or disability in important activities. not something that is a response to an expectable common stressor
- socially deviant behaviour only disorder if conflict results from a dysfunction in the individual.
- patterns of abnormal behaviour associated with: psych dysfuntion, emotional distress, impaired functioning
- may depend on culture?
- 25% UK experience mh problem each year (underestimates) especially: women, young
8
Q
Rosenhan
A
- 3m 5f (inc himself) reported auditory hallucinations & admitted to 12 psychiatric hospitals
- all diagnosed
- diagnosed with schizophrenia ‘in remission’
8
Q
Rosenhan criticisms
A
- criticised by Spitzer
- identities of pseudopatients unclear & inconsistent reports (Cahalan 2019)
- Rosenhan’s own records who he described more severe symptoms
- pp’s dropped if they did not fit the narrative
- ‘sz in remission’ was as close to cure as possible and not the same as a diagnosed mental illness
9
Q
Spitzer: Father of DSM
A
- US Psychiatrist led to development of DSMIII
- DSMI and II were niche, III was ambitious and widely used.
- generally shifted from Kraeplins emphasis on neuropathological cause. DSM III did not discuss cause much
- empahasised importance of empirical findings than philosophical thoughts in defining conditions
- use of reliable signs and symptoms of conditions
- removed homosexuality as mh condition
9
Q
DSMIII II-TR & IV-TR
A
- removed freudian term ‘meurosis’ revised om DSMIII-TR
- DSM IV (1994) led by Allen Frances established a core definition of a mental health condition emphasising functional impairment & clinically significant distress
- used field trials to test reliability of diagnoses
- included some dimensional phenomena but mostly categorical
- long gap before DSM5 which defined a mh condition in broader terms.
10
Q
Classifying MH difficulties
A
- DSM5 classifies conditions not people who have them.
- categorical system now with some dimensional severity ratings (541 diagnoses)
- included many new diagnoses at the threshold of normality with potential to reclassify many as mentally disordered - risk of over diagnosis?
11
Q
Problems with DSM
A
- over reliance on medical model assumes can treat in same way
- no clear line between having a disorder vs not and vs a different disorder
- Kraeplin: each category of condition should have a specific biological pathology that accounts for it and specific therapy to treat it - not the case in DSM5.
- pathologising normal experiences?
- how valid and reliable?
- symptoms are generally dimensional but not always normally distributed
12
Q
Current approach to mental health conditions
A
- current approach links social psychological and biological factors. some social factors deterministic so we have indiv difs in profiles of risk and resilience of factors
- factors e.g. spiritual, epigenetic changes, broader environ influence perceptions of mh.
13
Q
key terms
A
- incidence - no. of new cases of a condition/symptom in specified pop specified time
- cure/remission - the rate at which the condition/symptom ceases to be present
- recurrence - rate at which a condition/symptom occurs again in people who previously had it
- prevalence - % or no. cases per 100,000 etc. can be point prevalence (at specific point in time) period (e.g. past 12 months) or lifetime.
- aetiology - process a disorder develops
- course - progression of a disorder over time
- comorbidity - concurrent condition alongside another
- odds ratio - probability of an event happening compared to alternative. 1 = equal odds.
