Lecture 19 - mental illness and ADHD Flashcards
Is mental illness a fiction?
- Cultural norms are attaching labels to particular behaviours that were not considered deviant before.
- Mental illness is stigmatized. Label of mental illness carries many repercussions.
Bernice A. Pescosolido - stigmatizing attitudes toward adults and children by vignette type and social venue
- There is more literacy about mental illnesses.
- And more tendency to seek help. Reach out to friends.
- With this labelling, do we have more or less stigma and how do we measure this stigma?
- She divided results between children and adults.
- Unwillingness to engage intimately with people with mental illness (drug dependence, depression, alcohol…)
- Some even refuse any type of social construct with these individuals
- Less stigma with children.
- This is robust, regardless of the increase in awareness.
Debate about mental illness and stigma
- Does stigma arises from non normative behaviours that constitute mental illness (symptomatology)
- Different cultural context/country
- Different stigma based on the context (ie: is it medicalized)
- More labels and more public awareness
Does more labels and more awareness lead to more stigma or less.
Are we stigmatizing the behaviours or the labels themselves.
Does from cultural meanings attached to the label of mental illness that trigger prejudice
- Both factors were significantly associated with stigmatizing responses.
- Individuals who recognized a vignette as a “mental illness” were also more likely to give stigmatizing responses. The label of mental illness mattered, even controlling for behavior.
- Respondents endorsing mental illness were twice as likely to report a potential for violence and five times as likely to support coercive treatment as well as express a preference for greater social distance
Increase in literacy about mental illness:
- Greater number and range of mental health problems
- Substance abuse (from 7.1 percent to 15.5 percent),
- Developmental disorders (from 6.5 percent to 13.8 percent),
- Nonpsychotic problems (from 7.1 percent to 20.1 percent)
- The public can differentiate between “problems of daily living” and standard psychiatric categories.
The idea that knowing or labelling will detach behaviors from stigma is not necessarily true
- People do not have more empathy for neurobiological conditions, there is actually more stigma.
- Goffman = inner inflicted stigma, it starts with how we perceive ourselves.
The false dichotomy of mental illness
- Completely sane vs completely insane category
- This separation between mentally ill and normal is problematic
- Even sane people are not sane all the time. The insane are not always insane.
- As long as we can find an explanation for abnormal behaviour than we are not worried (ie: hallucination caused by drugs = not insane)
- We should break it into a continuum
- The threshold for it being “insane” when it intervenes with expected activities
- Who gets to make the diagnosis, is it subjective, can we step back from the label
- If we are all constantly playing specific roles to adapt to social status (goffman), when can you step back from this.
When did the shift to deinstitutionalization start?
- Tendency to institutionalize people in assylums in the 50s
- 50-60s: shift to deinstitutionalization - closing the assylums
- 90% of patients in US that were institutionalized are released. This happens in many countries
Why did this shift to deinstitutinalization occur?
- The state should not interfere, people should be able to take care of themselves (personal responsibility).
- Having all these institutions are expensive (taxes) - the government wants to allocate money to other things.
- We normalize behaviours as deviant as long as it makes sense for capitalism (when it’s too costly, we make it not deviant)
What were the 4 push factors for deinstitutionalization?
- Academic Critiques - academic people intervene in public debates and want to reform these institutions.
- Drug Therapy - main reason: effective drug taking, allowed patients to function outside of mental institutions. Allowed people to regulate social behaviours.
- People medicalized through opioids - led to reliance on the drugs = led to suicides and death
- The Civil Rights Movement - rise of people who are in the asylum = majority of them are marginalized (women, LGBTQ), they are using it to marginalize individuals
- Economic Considerations - expensive to keep these running (you have vietnam war and war on drugs which drown welfare ressources)
Pros and Cons of deinstitutionalization
- There was a positive aspect to this movement.
- Community model however is problematic because there were no services to help cope with their mental lness.
- Medications also had a lot of side effects - often stopped using them → revolving door phenomenon.
- Led to homelessness: ⅓ of homeless individuals are people released from institute
- Half of inmate population is found to be suffering from mental illness.
- Dismantling of one social control recreated a form of deviance elsewhere = People that left these institutions moved into the streets and then ended up in jail.
- Commitment to mental hospitals was more of a form of social control than it was to help people.
Attention deficit/hyperactivity disorder (ADHD)
● Common neurodevelopmental psychiatric disorder
● Defined as: Age inappropriate levels of inattention and/or impulsivity and hyperactivity (American Psychiatric Association, 2013).
● The worldwide prevalence has been estimated at 3.4–5.3 % in childhood/adolescence and 2.8 % in adulthood
Diagnosis expansion
● 1960s: Hyperactivity and impulsivity deemed the characteristic symptoms.
● Predominant diagnosis to School children (primarily aged 6–12), mostly boys
● The condition would diminish by adolescence and disappear completely in adulthood
● 350,000–500,000 children in U.S diagnoses this way
● Treatment: Retalin
● Diagnosis for ADHD either for hyperactive behavior or attention problems
Diagnosis expansion - Gender and Symptoms
● 1994: DSM IV Attention deficit hyperactivity disorder ADHD
● Add: Hypoactive” or “spacey” (mostly girls) → sitting quietly daydreaming
● 10-to-1 to 3-to-1 boys to girls: expansion to include gender
● Diagnosis for ADHD either for hyperactive behavior or attention problems
Diagnosis expansion - Age
● Preschool children as young as 3 years were being diagnosed and treated for ADHD (6.4 million children, CDC 2014)
● 1990s adult ADHD mostly among adults who had never been diagnosed as children (4 million adults, CDC 2014). → addition of adult ADHD
● From a children’s disorder to a life span disorder
Diagnosis expansion
● Widening the ADHD net,
● Increasing the labeling of ADHD,
● Increasing the number of individuals treated for the disorder usually with psychoactive medications like Ritalin, Adderall, and Concerta
● From U.S to the rest of the world (geographic expansion) → different ratios in different countries
Attention deficit/hyperactivity disorder (ADHD) - prevalence statistics
- Canada : children alone (aged 3 to 9 years) indicated that ADHD prevalence across
provinces is approximately 1.1% for preschoolers and 4.1% for school-aged children (Espinet SD 2022) - Canada: adults ranging from 2.7% or 2.9% (across all provinces) to 7.3% (across five
provinces)
- Young adults : 18 to 34 years - 7.3%
- Older adults: 35 to 64 years- 5.5% (Espinet SD 2022) - Canada: prevalence of ADHD is approximately twice as high amongst males compared to females
- Males range from 3.7% to 13.3%
- Estimates for females range from 1.5% to 7.0% - ADHD diagnosis and the number of patients prescribed ADHD medication are increasing over time
- The highest increase in ADHD prevalence across time (1999 and 2012) was found for Quebec (3.5%)
- 2019 National College Health Assessment: Almost 8% of Canadian students were treated or diagnosed with ADHD in the past 12 months
- But ….methodology changes and varies.
Diagnosis of ADHD
- Etiology influence a estimates. - etiology is hard to identify
- ADHD is a blanket term covering a multitude of conditions with a variety of causes
- International Classification of Diseases (ICD)
- Diagnostic and Statistical Manual of Mental
- Disorders (DSM) criteria
- Diagnostic criteria change across time
- Change in symptom onset and exclusion criteria from DSM-IV to DSM-V.
- Methodological variability within and across the studies
- Data sources and case determination
- Self reported symptoms ?
- Diagnosis from health professional?
- National data base ?
Causes of ADHD: Thomas Armstrong (1)
1) Short attention span culture’
* Jolts per minute
* We need to be jolted to be aware and present
* Viewing television and other media in exces can have an effect upon neurological development in children
* Creates a sensation in where we are used to these jolting responses. Neural mechanisms - now you need to be jolted by more stimulation.
* This creates a deficit of attention which creates a lack of ability to concentrate when there is a “light form” of stimulation
* Neurotransmitter dopamine -> stimulus seeking
* Children identified as ADHD require higher levels of stimulation than the average person
* Retalin provides the missing stimulation in chemical form
Causes of ADHD: Thomas Armstrong (2)
2) Decline of free and unstructured play
* Now confined to rooms, small backyard…
* Controlled by overprotective parents.
* ADHD : dysfunction in frontal lobes, striatum, limbic system, and cerebellum.
* Problem mediating motor and emotional responsesand inhibitory control over those responses
* Genetic causes ?
* Play modifies brain structure: creates capacities (stop ourselves from reacting).
* We learn during games how to develop these cognitive processes/skills that we will need in love.
Precipitated Development
● 1970s
● Accountability
● Test scores
● ‘Hurried child syndrome - push them towards achievement which rates strain this leads to symptoms similar to ADHD.
- Young kids show ADHd behaviours and its normal
● Symptoms: headaches, nausea, irritability, learning dysfunction,attentional difficulties, and behavioral problems
● The symptoms of ADHD are developmentally normal for infants
● Neotenous qualities- important for the society
Einstein - kidlike, never grew up - we should not push them to grow up and be mature. This aspect of pushing kids is leading to ADHD. We are pushing children to grow up even though they are busy just being children.
ADHD as a social construct?
- When we didn’t have education, we didn’t have ADHD.
- When we didn’t have a test, we didn’t have an ADHD diagnosis.
