Lecture 2 Flashcards
What are some of the ways that professionals might interpret and respond to mental health symptoms?
- one interpretation is that a person has a disease with a biological cause
- a person has a disorder
define disorder
a dysfunction that is mental in nature, whatever the cause
Who experiences cardinal symptoms of some mental illnesses like sadness (depression) and worry (anxiety)?
- EVERYONE
- even mental health experts may find it difficult to define line between “healthy” and “unhealthy” degrees of these emotions
- It may be possible that the symptoms and behaviours are within the spectrum of normal human responses to stressors
What does good mental health look or feel like?
- routine
- tasks
- meet social role / responsibilities
- feel happy / satisfied
What does poor mental health look or feel like?
- self-loathing
- unmotivated
- lazy
- no self-love
Review what is meant by mental health and illness
- The definitions of “Mental Health” and “Mental Illness” are not straightforward!
- One possible definition: Mental health is the freedom from suffering, abnormal
behavior, and distress - Another possibility: Mental health is the absence of mental illness
- Neither of these are very definitive! It might be useful to explore the concepts of distress, abnormality, and dysfunction…
define “mental”
- refers to feelings, awareness, cognition (thinking/learning), behavior
What is health and illness associated to
- health is associated with feeling good, while illness is associated with feeling bad
what is dysfunction
When a person’s thoughts and feelings make it difficult for them to meet their daily needs and fulfill typical responsibilities
- however, individual capacity is influenced by a person’s resources and environment
ex. a person may be able to afford days off work when distressed but another person may not be able to and is more adversely affected in terms of fulfilling role responsibilites
What is the WHO definition of mental health?
“a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community” (WHO, 2013)
- definition points to the interaction of people with their community - but some people have less ability to contribute to society due to sexism, racism, ageism, etc. not due to anything about the individual person
- does it make sense to call such a person not as mentally healthy?
What is the DSM definition of mental illness?
- refers to disturbances in cognition, emotion, or behavior which can be attributed to mental functioning and which usually are associated with distress or disability
- this def touches on distress, abnormality, and disability and also relies on the professional judgement of a clinician for diagnosis
What does the DSM stand for?
Diagnostic and Statistical Manual of Mental Disorders
What are some strengths of the DSM definition?
- it’s a flexible definition using words like “usually” and describing the dysfunction as being “psychological, biological, or developmental”
- “bridges” a variety of perspectives about nature of mental illness making it possible for variety of mental health professionals to use it
What are some limitations of the DSM definition?
- flexibility in definition may indicate lack of strong evidence about nature of mental illness
What are the 3 models of mental health and illness?
- biomedical
- psychological-behavioural
- social
explain the biomedical model
- binary division (a person is either mentally ill OR mentally healthy
- sees good mental health as the natural human state
- uses a model of disease to suggest that mental illnesses have specific causes: Biological dysfunction of the brain (even if cause not yet understood or known), genetic
In the biomedical model, what interventions are considered the best way to treat mental illness?
- brain-based interventions
What are the 3 brain-based interventions?
- Psychopharmaceuticals
- Electroconvulsive therapy (ECT)
- Genetic interventions (potentially in the future)
Define biomarker
- a measurable substance in the body that definitively indicates the presence of a disease
- there are virtually no biomarkers of mental illnesses universally agreed upon, raising questions about whether it is a disease
is there a test to prove someone is in good mental health?
no
Explain the psychological-behavioural model
- considers mental disorders to be patterns of thinking, feeling, and behaving that are harmful to the individual
- does not assume a binary between mental health and mental illness
- assumes that symptoms exist along a continuum
- with mental health and mental illness as 2 extremes on a continuum
What are 4 of the schools of thought/practice?
- Freudian Psychoanalysis
- Psychodynamic approaches
- Behaviorism
- Humanism
- all of these support the idea that mental illness arises as a result of our personal experiences and perspectives (ex. childhood experiences shaping thoughts/feelings)
What does treatment within the psychological-behavioral model rely on?
- relies on psychotherapy
What are the types of psychotherapy?
- cognitive behavioral therapy
- psychodynamic treatment
- humanistic therapies
- existential approaches to therapy
Explain the social model
- sees mental health as a social product
- this means that good or bad mental health are socially constructed and produced (defined and re-defined by social relations and norms)
- this model places less emphasis on individual characteristics and qualities, and considers the individual in the context of their social environment
What are some examples from the social model?
- homosexuality no longer considered a mental illness
- shyness in the past considered “normal human quality” may now be referred to as social anxiety disorder
- auditory hallucinations : hearing one’s dead ancestor is celebrated in some cultures
this suggests that power and culture lead to the labelling of some people, often those who are marginalized, as mentally ill
- behaviors that are more common among some groups may be more likely to be labelled as symptoms of mental illness
What is a suggested response to mental illness to improve it
social interventions like supported housing, employment, and skill building
define demedicalization
- a process by which issues that are understoof as medical problems are redefined and understood through other perspectives
what does demedicalization mean in the social model
- means de-classifying a mental illness and looking at social causes rather than individual causes of mental distress
Explain the biopsychosocial model
- suggests that biological factors, social conditions, and individual expereinces all contribute to a person’s mental health
- integrates persepctives form the 3 models
- social in this context refers to social determinants of health, such as income, housing education, etc.
give examples of some providers of mental health care that delivery care and support to people with mental illness
- psychologists
- psychiatrists
- social workers
- registered psychiatric nurses
- counsellors, therapists, psychotherapists
- life coaches
- religious advisors
- also “peers” or people with lived experience of mental illness - “fellow patients/clients” (current or former
What do psychiatrists do?
- trained medical doctors (MDs) who specialize in mental illness
- capable of prescribing certain treatments
- typically possess legal powers
What do psychologists do?
- not physicians
- cannot typically prescribe medications
- still perform diagnosis and psychotherapy
What do social workers do?
- often at the forefront of providing care to individuals with mental health difficulties
- may provide psychotherapeutic services
- helps individuals with mental health problems meet their daily needs
- may provide both therapeutic and practical assistance
What do nurses who specialize in mental health including registered psychiatric nurses do?
- perform mental status examinations that assess qualities like mood, cognition, judgment, and behaviour
- assess and assist with patients’ overall health, ensure adherence to treatment plan and may conduct bloodwork
How would you know if you had a mental illness?
- self-check test
- doctor diagnosis
What does determining mental health and illness require?
- subjective assessment (by a clinician)
What are 3 diagnostic tools?
- Diagnostic and Statistical Manual of Mental Disorders (DSM)
- International Classification of Diseases (ICD)
- Clinical Scales
Explain the DSM
- produced by American Psychiatric Association
- descriptions of each diagnosis (or disorder), and includes a checklist of their symptoms (thoughts, moods, behaviours) used to determine if a specific diagnosis applies
- a practitioner observes and speaks with patients/clients to gather info used to make a diagnosis
- evolves with each new edition
describe ICD
- produced by WHO
- includes all recognized health conditions (not just mental disorders)
- also includes diagnostic criteria
- definitive classification schemes are highly relevant to public health - we use them to track mortality, morbidity, and treatment in health administrative data
Describe Clinical Scales
- measure patients mental state with a series of “standard” questions
- answeres can be used to determine severity of the condition
how do clinical scales work?
- “score” for every item or question is calculation
- the total indicates whether the person qualifies for the diagnosis and how severe their condition may be
What is an example of clinical scales
the Hamilton Depression Rating Scale
Explain the Hamilton Depression Rating Scale
- 17 items measure the severity of depressive symptoms
- the interviewer rates the level of agitation clinically noted during the interview and how the mood is impacting on an individual’s work or leisure pursuits
- scoring is based on the 17-item scale
What is the scoring for the hamilton rating scale
- 0-7 are considered as being normal
- 8-16 suggest mild depression
- 17-23 moderate depression
- over 24 indicates severe depression
- the maximum score being 52 on the 17-point scale
What are the potential causes of bias in diagnosis?
- classification systems are human-made and subject to biases (not robots)
- clinicians may display biases related to patient characteristics: race, class, gender, weight
- clinician characteristics may be influential too: training, race, gender
- potential for bias in diagnostic criteria: symptom lists and criteria may make some individuals more likely to be diagnosed with particular conditions
- unrecognized class/race/gender bias among those creating diagnostic criteria
Describe committees
- homogenous groups
- lacks diversity
- upper middle class, largely white
- may lead to diagnostic criteria that function to reinforce cultural norms
- unrecognized or un-reported conflicts of interest may exist
