mental health Flashcards

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1
Q

how is a mental disorder defined?

A

a clinically significant behavioural or psychological syndrome/pattern that occurs in an individual

typically associated with a painful symptom or an impairment in one or more impairment areas of functioning

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2
Q

what was trepanning?

A

earliest supernatural explanation for mental illness

evidence of prehistoric skulls and cave art identified surgical drilling of skulls to treat head injuries, epilepsy and to release evil spirits trapped within the skull

evidence from as early as 6500BC

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3
Q

what were the Old Testament / Early Judaism’s views on mental health?

A

‘madness’ was an all-encompassing term for psychotic and neurotic illnesses, and jt was perceived as a punishment from God

Saul became mad, which was evidenced by his slaughter of 55 priests for no reason, after he had angered God

interestingly, it is recorded in the Bible that music calmed Saul, perhaps the first documented treatment for madness

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4
Q

how did Early Civilisations (eg Chinese and Egyptian) view mental illness?

A

viewed mental illness as a result of possession of demons

treatments consisted of exorcism techniques (such as beatings, restraint and starvation) designed to drive demons out of the afflicted person’s body

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5
Q

what was the view of mental illness in Ancient Greece in Homer’s era? (800-700BC)

A

madness was still considered to be a punishment from the gods

the myth that Hera punished Hercules by ‘sending madness upon him’ illustrates this view

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6
Q

what was Hippocrates’ view of mental illness?

A

first identified mental illness as a scientific phenomenon

thought that madness resulted from an imbalance of the four bodily humours, and could be cured by balancing these.

they were blood, phlegm, yellow bile and black bile

depression was thought to be a result of an excess black bile (melaina chole) and diets, purgatives (laxatives) and bloodlettings wohld rebalance this excess

a significant advance on the theory of religion or mythology as it actually suggests mental illness is a real one to physical changes. This founded the medical model of medicine in Europe

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7
Q

what was Ancient Rome / Cicero’s view on mental illness?

A

Hippocrates’ theory of unbalanced humours was rejected by some and replaced with the belief that melancholy resulted from emotions such as rage, fear and grief

anxiety prone people had excessive perturbations (disturbances) of the mind

Cicero’s questionnaire for the assessment of mental disorders is very similar to the tools used today to assess a patient’s psychiatric history and mental state

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8
Q

what was Christianity’s view of mental illness? (around 300AD)

A

promoted the idea of madness as a punishment from God or demonic possession

it followed that religion was central to any treatment within medieval asylums such as the Bethlehem Hospital in London

some monastries also became centres for the treatment of mental disorders

however, older treatments such as bloodletting and purgatives continued alongside prayer and confession

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9
Q

what was the view of mental health in the middle ages?

A

between 11th and 15th centuries, supernatural theories dominated Europe (fuelled by natural disasters like plagued) that people interpreted as brought about by the devil

common treatments included prayer rites, relic touching, confessions and atonement

was suggested that accused witches were actually women with mental illnesses, and that mental illnesses were not due to demonic possession but due to faulty metabolism and disease.

witch hunting didn’t decline until the 17th and 18th centuries after more than 100,000 presumed witches had been burned at the stake

mental illness was viewed somatogenically so treatments were similar to those for physical illnesses (eg bleeding)

hospitals + asylums were established in the 16th century to house and confine the mentally ill, the poor, the homeless, the unemployed and the criminal

most inmates were institutionalised against their will, lived in filth and chained to walls. Also commonly exhibited to the public for a fee

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10
Q

what were the Enlightenment Thinkers’ views on mental health?

A

protests rose over the conditions under which the mentally i’ll lived. The 18th and 19th centuries saw the growth of a more humane view of mental illness— moral treatment.

Enlightenment thinkers suggested disorders resulted from emotions and stressors in the environment. Treatment began to treat patients morally

eg made environment more comfortable, kindness, walks, decorations on the walls

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11
Q

what was Freud’s view of mental illness?

A

mental illness is a result of the unconscious mind.

Typical causes = trauma or issues during development. Could be treated through psychoanalysis

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12
Q

what is electroconvulsive therapy?

A

ECT (electroconvulsive therapy) is still used today, but not as much as in the 1950s/1960s (and back then they weren’t out under anaesthetic)

used when people haven’t responded to medications. Involves sending electric currents through the brain to trigger a seizure — muscles only twitch slightly

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13
Q

what are lobotomies?

A

surgeons would place a sharp instrument into the brain and cut the connections between the frontal lobes and rest of the brain.

First in 1936

very popular in the 1940s.

Became abandoned once antipsychotic medication become available

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14
Q

what is the biopsychosocial model?

A

there is now a biopsychosocial model of explaining human behaviour

this
means individuals may be born with a genetic predisposition for a disorder but certain psychological stressors need to be present for them to develop the disorder

social factors include poor living conditions, problematic relationships and economic unrest.

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15
Q

what is the definition for abnormality regarding statistical infrequency?

A

behaviour is abnormal because it is statistically rare

it is hard on the idea that behaviour is normally distributed and it is usually argued that people who are 2 standard deviations above or below the mean are abnormal

eg only 1% of the UK population are affected by schizophrenia, so it is rare.

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16
Q

what are the advantages of the ‘statistical infrequency’ definition?

A
  • objective, based solely on frequency of occurrence so no bias
  • easy to calculate and therefore easy to identify abnormality
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17
Q

disadvantages of the statistical infrequency definition for abnormality?

A
  • arbitrary numbers, who decided on how rare something must be for it to be considered abnormal? the numbers are made up and potentially meaningless
  • not all rare behaviours are abnormal and not all common behaviours are normal
  • the statistics could be incorrect/unreliable, largely based on people going to the doctors but certain groups of individuals might be less likely to do that (eg men)

could be affected by culture, what is rare in one culture might be common in another

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18
Q

what is the deviation from social norms definition for abnormality?

A

every society has rules about what are abnormal behaviours, values and beliefs

we call these social norms and they are expected and accepted ways of behaving

behaviour is dysfunctional if it deviates from some notion of what the society considers proper or acceptable

there are also a number of criteria for one to examine before reaching a judgement as to whether someone has deviated from society’s norms

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19
Q

how does culture influence what is deemed abnormal by society?

A

norms are ethnocentric, eg in India, Schizophrenia is thouhjt to be caused by the possession of evil spirits

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20
Q

how does situation and context influence what is deemed to be abnormal by society?

A

the definition suggests all behaviour that breaks norms is abnormal

eg a drunk driver has broken a social norm but they are not considered to have a mental disorder— the definition doesn’t always fit all behaviours

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21
Q

how does age influence what is deemed normal by society

A

having a tantrum at
age 2 is normal but having a tantrum at age 16 is not

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22
Q

how does gender influence what is deemed as normal by society?

A

there are gender stereotypes, eg a male not crying, or females being nurturing and motherly. but these don’t necessarily make people normal/abnormal

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23
Q

how does historical context influence what is deemed as abnormal?

A

norms change over time:

  • homosexuality was once considered a mental disorder
  • being an unmarried mother in the 40s/50s would have been breaking social norms. some of the women were sectioned as ‘moral imbeciles’
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24
Q

advantages of the deviation of social norms definition for abnormality?

A

means it is potentially easy to identify (see) someone who is behaving in an abnormal manner

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25
Q

disadvantages of the deviation of social norms definition for abnormality?

A

Cultural relativism - of course this definition is hugely dependent on culture.
What is normal in one culture isn’t normal in another. This can influence how we judge and define abnormality.

What is deemed normal and acceptable by society changes so much over time - e.g. homosexuality was classed as a mental illness until 1973. This means this definition lacks reliability and validity - how can something be normal one year and not the next? (and vice versa)

Different subcultures may have their own set of norms which aren’t reflected by wider society.

Sometimes breaking away from norms of society can be a positive thing e.g. freedom fighters and activists.

Many people actually break social norms at some point e.g. committing minor criminal offences and it is unlikely in the majority of cases that this is due to a psychological disorder.

Social control - A diagnosis of insanity in Russia has been used to detain political dissidents and in Japan it has been used to ensure a strong work ethic. Szasz argues that abnormality is a socially constructed concept that allows people who are unusual to be labelled and thus treated differently from the others - often confined and persecuted. In the 19th century women were frequently diagnosed with moral insanity. This was diagnosed when women who inherited money spent it on themselves rather than on male relatives. By being able to get women diagnosed with moral insanity (with the cooperation of male doctors) men were able to strictly control women in line with their own interests.

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26
Q

examples of cultural relativism?

A

a Chippewa boy who saw visions of thunderbirds whilst at school. Western society sees visions as symptoms of schizophrenia whereas in the boy’s own culture, the visions are seen as a great honour

in one pacific island society, social life is governed by hostility and suspicion. gifts of food are assumed to be poisoned, and a poor crop is attributed to theft by magic of nutrients from the soul. Anyone who is friendly is considered crazy

In some countries, people eat insects, practice sorcery and encourage sex play among children. Whilst these behaviours seem abnormal to us, many people in the world view American behaviours as abnormal, eg birth control, having one spouse and bottle-feeding infants

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27
Q

what is the failure to function adequately definition for abnormality?

A

This definition of ‘dysfunctional behaviour defines whether or not a behavior is ‘dysfunctional’ if it is counter-productive to the individual.

If a person is not functioning in a way that enables them to live independently in society then they are potentially failing to function adequately.

  • The main problem with this definition however is that psychologists cannot agree on the boundaries that define what is functioning and what is ‘adequate.
  • Behaviours that prevent people from coping with the demands of everyday life such as the ability to work or the motivation to care for themselves properly are considered dysfunctional.
  • There are several reasons why a person may not be functioning well.
    These might be:
  1. Dysfunctional behaviour - is the behaviour maladaptive?
  2. Personal Distress - is the individual experiencing the behaviour distressed?
  3. Observer discomfort - are other people affected by the behaviour?

4.Unpredictable behaviour - is the behaviour unexpected in that situation?

  1. Irrational behaviour - does the behaviour make sense in that situation?
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28
Q

advantages of the failure to function adequately definition?

A

gives us a definition which takes into account how other people feel, eg observer discomfort

this is useful as sometimes the individual with the disorder does not feel distress themselves but those around them do

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29
Q

disadvantages of the failure to function adequately definition?

A

it is subjective – people may disagree on what it means to function adequately

many normal people fail to function adequately during their lives, perhaps in particularly stressful situations

there may be cultural issues– what is adequate functioning may differ between cultures

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30
Q

what is the deviation from Ideal Mental Health definition?

A

this definition defines dysfunctional behaviour by determining if the behaviour the individual is displaying is affecting their mental wellbeing

as with the failure to function definition, the boundaries that stipulate what ideal mental health is are not properly defined, and the bigger problem with the definition is that all individuals will, at some point in there life, deviate from ideal mental health, but it does not mean they are dysfunctional

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31
Q

what was ideal mental health according to Marie Jahoda (1958)?

A

a positive attitude towards oneself

the opportunity to self actualise

the ability to resist stress

autonomy; being independent and self regulating

an accurate perception of reality

the ability to adapt to one’s environment

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32
Q

advantages of the deviation from ideal mental health definition?

A

it is the only definition which attempts to define normal or what is ideal, which we need to no in order to identify what is not normal

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33
Q

disadvantages of the deviation from ideal mental health definition

A

what is called as ideal is very subjective

the criteria suggested by Jahoda are quite demanding, so there would be quite a lot of people who would not achieve them, which means you would identify a lot of people are abnormal and this totally contradicts statistical infrequency

there is an issue of culture – these are potentially ethnocentric as the ideals might fit with individualistic countries and not collectivist ones

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34
Q

what does it mean to categorise mental disorders?

A

the diagnosis of mental disorders follows the same process as when assessing physical illness – identify symptoms (both medical and non-medical) in order to help you identify the sort of illness a person has and begin treatment

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35
Q

what two categorisation tools are used?

A

the DSM V and the ICD

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36
Q

what do the categorisation tools do?

A

both the ICD and the DSM comprise of a list of all recognised mental health conditions with symptoms which indicate a particular disorder

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37
Q

what do the categorisation tools not do/offer?

A

they do not offer explanations for disorders or suggestions for treatments

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38
Q

what is the main purpose of the categorisation tools?

A

by having a list of symptoms used by all professionals, the reliability of diagnosis should be improved

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39
Q

who is the DSM published by?

A

the American Psychiatric Association

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40
Q

what is the DSM?

A

currently on its 5th edition (DSMV)

a manual and categorisation tool used by medical professionals to diagnose mental disorders

contains descriptions, symptoms and other criteria for diagnosing mental disorders

provides a common language for medical professionals to communicate to their patients and also ensure consistency in research

establishes consistent and reliable diagnoses

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41
Q

what is the ICD?

A

the latest version was released in 2018

devised by the WHO

often used alongside the DSM

a globally used diagnostic tool for both physical and mental health

also used for morbidity and mortality statistics

used by more than 100 countries around the world

has 22 chapters but only chapter 5 is about mental disorders

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42
Q

what are two ways that the DSM has changed over time?

A

was initially very focused on the psychodynamic perspective

the term ‘reaction’ for disorders was dropped in the DSM II (1968)

DSM III attempted to be neutral with respect to causes of mental health

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43
Q

advantages of the categorisation tools?

A

standardises the diagnosing of mental disorders across different treatment providers

can guide mental health professionals in providing treatments, give people access to other support and services eg benefits

can help aid research

should be a valid tool for diagnosing mental illness

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44
Q

disadvantage of the categorisation tools: is human behaviour too complex?

A

diagnostic tools can oversimplify complex behaviour

there is an argument that manuals are reductionist

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45
Q

disadvantage of categorisation tools: is there a risk of over diagnosis?

A

there is a concern that the threshold for diagnosis has lowered too much and could result in people being diagnosed when they do not have a disorder

eg previous DSMs required 3/6 symptoms to be present for at least 3 months for a diagnosis of Generalised Anxiety Disorder. in DSMV, only 1 / 4 symptoms are required to be present for at least one month

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46
Q

disadvantage of the categorisation tools: are big pharmaceutical companies too involved in categorisation?

A

krimsky and cosgrove (2012) found 69% of the people on the panel to approve the DSM-5 had links with pharmaceutical companies which could have biased their judgement

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47
Q

disadvantage of the categorisation tools: what about the treatment of disorders?

A

these tools offer a starting point – they don’t indicate what caused the disorder, and doesn’t suggest a treatment

some people argue that by categorising disorders you create a label - and maybe this could be harmful to people

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48
Q

is the categorisation/ diagnosis of mental disorders valid?

A

Ford and Widiger tested clinicians and found a gender bias. men more likely than women to be diagnosed with anti social personality disorder, whilst women were more likely to be diagnosed with Histrionic Personality Disorder

stereotyping– the symptoms listed sound specific to one gender sometimes. That is why it is important they get updated. eg amenorrhea (not having period) was removed as a symptom of anorexia nervosa

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49
Q

is the categorisation/diagnosis of mental disorders reliable?

A

practitioners have questioned the reliability of the DSM

Spitzer and Fleiss (1974) found the reliability of diagnosing is poor. they used something called Kappa - this is a measure of agreement between 2 clinicians diagnosing the same patient. the measure ranges between -1 and 1, with 1 being perfect agreement between 2 clinicians

these researchers found a Kappa agreement mean of 0.52 - concluding no category of mental disorder has consistently high reliability when it comes to diagnosing patients

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50
Q

is there an issue of ethnocentrism with categorisation?

A

symptoms are developed from a Western perspective which may be an issue

behaviours which are considered abnormal in one culture may be considered normal or even desirable in another

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51
Q

how can diagnosis cause labelling and stigmatisation?

A

perhaps by giving a certain behaviour a name you are making it seem like that person is different

categorisation could be socially sensitive as labelling could lead to stigmatisation

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52
Q

how can changing social norms be seen as a problem with categorisation?

A

some pervious disorders no longer exist due to changing norms

what is classified as a disorder changes over time, so those categorised with disorders now may not be in the future

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53
Q

what was the overall aim of Rosenhan?

A

wanted to see if it was possible to tell the difference between sanity and insanity in a person, and whether hospitals really could tell the difference between someone who is sane and someone who is insane

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54
Q

what was rosenhan exp1 procedure?

A

8 pseudopatients rang the admissions office of 12 psychiatric hospitals over 5 states in America.

the hospitals were a mix of old and new facilities, had a range of staffing levels, and one was a private hospital relying on patients’ fees for their funds

each pseudopatient would call one of the hospitals and say they were hearing voices. they said they could hear the words ‘empty’ ‘hollow’ and ‘thud’

they said they were not familiar with the voice and that the voice was of the same sex as them

they gave false names, addresses and jobs, but everything else was the truth

once they were admitted they acted normally, with no mention of symptoms again. they did everything they were asked eg going to dinner, but they did not swallow any medication

the pseudopatients kept notes of everything that had happened on the ward

they were only able to leave if they were discharged

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55
Q

who were the participants in Rosenhan Exp1?

A

the people in the hospital, NOT the pseudopatients

data was collected on other patients and medical staff

only in one hospital did the hospital administrator and chief psychologist know what Rosenhan (himself as the pseudopatient) was doing

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56
Q

results of rosenhan 1?

A

there were 12 possible admissions (as 12 hospitals were tested)

11 of these admissions were for schizophrenia, the other was for bipolar disorder

the pseudopatients were never detected by the staff as being fake

the time the pseudopatients spent in the hospital ranged from 7 to 52 days. the average stay was 19 days

they were discharged as schizophrenic in remission

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57
Q

what were the comments from the other patients in rosenhan 1?(and how many people voiced their suspicions?)

A

in 3 hospitals, 35 out of 118 patients voiced their suspicions about the insanity of the pseudopatients, saying things like ‘UR not crazy’ ‘ur a journalist, or a professor’ ‘ur checking up on the hospital’

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58
Q

what was noted about the queueing behaviour in rosenhan1?

A

a group of patients sitting outside the entrance to the dining room half an hour before lunchtime were labelled as ‘oral acquisitive behaviour’ when they were actually just there because it was something to do

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59
Q

what was said about writing behaviour in rosenhan 1?

A

making notes on the behaviour of the medical staff and patients was seen as an aspect of their pathological behaviour

continuous writing was thought to have been a behavioural manifestation of their disorder

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60
Q

why did these results happen in the first experiment of rosenhan?

A

there could be a bias towards calling a healthy person sick (a false positive, type 2 error)

it is argued that it is safer to call a healthy person sick, than a sick person healthy, as then that person would fail to get the treatment they needed

calling a sick person healthy is a false negative, type 1 error

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61
Q

what was Rosenhan Exp2?

A

staff at a research and teaching hospital doubted Rosenhan’s findings and were certain they would identify pseudopatients, so Rosenhan tested this

the staff of the hospital were falsely informed that during the next 3 months, 1 or more pseudopatients would attempt to be admitted into their hospital

staff members were asked to rate on a scale of 1 - 10 (1 = high confidence) each patient, as to the likelihood of them being a pseudopatient

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62
Q

results of rosenhan 2?

A

during the 3 month period, 193 patients were admitted

at least one member of staff rated 41 patients as highly confident they were a pseudo patient

23 were rated highly confident they were a pseudo patient by at least one psychiatirist

19 were rated highly confident that they were a pseudo patient by a psychiatrist plus one other member of staff

NONE of them were pseudo patients, they were all genuine patients

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63
Q

conclusion from rosenhan 2?

A

it is just as easy to judge a sick person as healthy and make a type 1 error

perhaps this was because the staff at the hospital were told there would be pseudo patients so were biased towards identifying them

it does suggest that massive errors can be made in diagnosis - the big question is why?

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64
Q

in rosenhan, what was the experience like in the psychiatric hospitals?

A

staff and patients were segregated, with pseudos spending time in the ward and the dayroom. staff tended to only come out to administer medication or therapy, to attend a patient conference or to instruct or reprimand a patient

rosenhan said it was if ‘the disorder that afflicts their charges is somehow catching’ - they avoided their patients like they were contagious

average amount of time spent by attendants outside of the work room was 11.3% of their shift

it was rare to see a staff member talking with patients or playing games with them

the average time nurses spent outside the work room was so small it was deemed immeasurable

the number of times they left the work room was 11.5 times per shift, in night shifts this reduced to 9.4 times

the range was 4 - 41 times, suggesting some staff were much more likely to leave the work room than others

doctors and psychiatrists were seen even less often, they left their office on average 6.7 times per day

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65
Q

what is the stickiness of labels (rosenhan)

A

this is when your behaviour is viewed and interpreted differently due to being labelled, the diagnoses that were made were not based on the patients ‘normal’ backgrounds, but their case histories were interpreted based on the label they had been given

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66
Q

powerlessness demonstrated in Rosenhan?

A

patients often powerless to influence the interactions with medical staff, and could be punished verbally and physically by staff, although this stopped when other staff (not other patients) came into the room

a real patient was beaten bc he approached an attendant and told him ‘i like you’

patients had lost many legal rights, they could not initiate contact with staff, and staff ignored them if they did try to talk to them, often just walking straight past

no privacy, either in the patient’s possessions or case notes, which could be seen by anyone

patient was often monitored during bath and toilet times, sometimes there were no doors on toilets.

physical examinations took place in semi public place with other staff members there, and staff would point to patients + discuss them as if they were not there

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67
Q

depersonalisation shown through rosenhan?

A

main concern was the lack of time patients spent with their medical staff. the average daily contact with psychiatrists, psychologists and doctors combined ranged from 3.9-25.1 minutes, with overall mean of 6.8 minutes. This was over a total of 129 days that the pseudo patients were in hospital

staff did not care if medication was taken or not, the pseudopatients flushed theirs down the toilet, often finding other patient’s medication in there as well

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68
Q

what was rosenhan exp3?

A

in exp 1, the pseudopatients made comparisons of how the staff responded to patients which Rosenhan then compared with responses of other people to some individuals who had not been diagnosed with a psychiatric illness

in 4 hospitals a pseudopatient approached a staff member with a request such as ‘Pardon me, Mr/Mrs/Dr X, could you tell me when I am likely to be discharged?’

data was also collected from stanford university; a young lady would approach a faculty member and ask them for assistance

they also collected data from a university medical centre

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69
Q

findings of rosenhan 3?

A

out of the hospital and on the uni campus, all questions were answered, with nobody moving on without stopping

in psychiatric hospitals, only 6% of psychiatrists and 2.5% of nurses and attendants stopped or paused to talk

in medical centre, more people stopped, at least pausing, except for when the person said after the first question that she was looking for a psychiatrist - even the hint of mental illness is enough to reduce the amount of personal contact

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70
Q

what are the consequences of labelling and depersonalisation?

A

this research appears to show that we cannot distinguish sanity from insanity, and it is worrying how this type of label, even if it is wrongly applied, can be used

people can be needlessly stripped of their rights, eg the right to vote or handle their own bank accounts. the stigma attached to labels of mental illness can stick to people and affect their lives forever.

finally patients might be sane outside of the psychiatric hospital but seem insane inside due to the bizarre setting they are responding to

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71
Q

conclusions of Rosenhan’s study?

A

as we cannot judge the same from the insane, it makes sense not to admit people to hospital with labels that will stick to them but to have community based therapy where they are treated as humans without a label, with therapy for specific behaviours rather than just a named disorder

the hospital environment only magnifies the distortion in the behaviour of others towards the patients

the staff in the hospitals were not malicious or stupid, but just reacted as directed by the hospital environment. There needs to be some increase in the understanding and sensitivity of mental health workers towards the psychiatric patients. this may be achieved by education or experiencing impact of hospitalisation

must be noted that the experience of pseudopatients may be nothing like that of nothing of true patients

the research was carried out in the 1970s so may lack validity as (we hope) the situation in mental health facilities would be very different today

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72
Q

what is an affective disorder + example?

A

disorders characterised by disordered mood

eg depression

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73
Q

what is a psychotic disorder?

A

severe mental disorders that cause abnormal thinking and perceptions. people with psychoses lose touch with reality

eg schizophrenia

74
Q

what is an anxiety disorder?

A

a group of mental disorders characterised by feelings of anxiety and fear

eg phobias

75
Q

what are the characteristics of affective disorders?

A

relates to mood and mean that the disorder prevents the individual from leading a normal life. They include disorders such as depression, where an individual may feel intense feelings of despair, and bipolar disorder, where a person will have severe mood swings

76
Q

dsmv classification of depression?

A

5+ symptoms present during the same 2 week period, including either symptom 1 or 2 from:

1) depressed mood most of the day, nearly every day
2) diminished interest/pleasure in all or almost all activities, most of the day, nearly every day

  • weight loss of more than 5% not due to diet
  • insomnia / excessive sleep nearly every day
  • restlessness / less activity nearly everyday
  • fatigue or loss of energy nearly every day
  • feelings of worthlessness/ excessive guilt nearly every day
77
Q

ICD 11 classification of depression?

A

patient must show at least 2 of the 3 most ‘typical’ symptoms plus at least 3 of the ‘other’ symptoms

typical: depressed mood, loss of interest/enjoyment, increased fatigue

other: reduced concentration, reduced self esteem, disturbed sleep, diminished appetite

78
Q

what are the characteristics of psychotic disorders?

A

characterised by major disturbances of thought, emotion and behaviour

psychotic disorders generally relate to a loss of touch with reality which often leads to withdrawal from the outside world, confusion and disorientation

schizophrenia is probably the most well-known of this type of disorder

79
Q

what is the DSMV classification of schizophrenia?

A

2+ symptoms in one month, at least one must be symptom 1,2 or 3:

1) delusions

2) hallucinations

3) disorganised speech

4) disorganised/ catatonic behaviour (unresponsive)

5) negative symptoms (lacking something) such as diminished facial expression

symptoms should persist for 6 months and not be a result of other causes such as substances

80
Q

ICD 11 classification of schizophrenia?

A

minimum of 1 very clear symptom/ 2 or more less clear cut symptoms from a) to d)

OR at least 2 from e) to h).

symptoms should be clearly present for most of the time for 1+ months

a) thought echo
b) delusions of control
c) hallucinatory voices
d) persistent delusions
e) persistent hallucinations
f) breaks in train of thought
g) catatonic behaviour
h) negative symptoms eg apathy

81
Q

characteristics of anxiety disorders?

A

general feeling of anxiety accompanied by physiological symptoms such as increased heart rate and sweating

these are neurotic disorders and include disorders such as obsessive compulsive disorder, phobias, PTSD, and generalised anxiety disorder

anxiety disorders have in common symptoms of ty and avoidance behaviour that causes clinically significant distress or impairment of function. The specific emotions experienced are fear and or anxiety, which are characterised by:

  • physiological symptoms such as racing heart and disturbed breathing
  • behavioural discomfort and nervous gesturing
  • cognitive distraction
  • pre occupied with unwanted thoughts
82
Q

DSMV classification of agoraphobia?

A

marked fear or anxiety about two or more of these situations:
-using public transport
- being in open spaces
-being in enclosed spaces
- standing in a line/crowd
-being outside of the home alone

situations almost always provoke an anxiety attack and situations are avoided/ require a companion

fear is out of proportion to
danger

fear persists for 6 months and causes impairment of normal functioning

there are no other disorders / causes

83
Q

ICD 11
classification of agoraphobia?

A

all of the following should be fulfilled for a definite diagnosis

the symptoms should not be secondary to other symptoms such as delusions or obsessive thoughts

  • anxiety must be restricted to at least 2
    of:
  • crowds
  • public places
  • travelling away from
    home
  • travelling alone

avoidance of the phonic situation must be a prominent feature

84
Q

what are the explanations in the medical
model?

A

biochemical

genetic

brain abnormality

85
Q

what are alternative explanations to the medical model?

A

behaviourist

cognitive

psychodynamic

86
Q

what do the three medical
model explanations assume about the causes and treatments of mental illness?

A

the medical models assume
abnormal behaviour is a result of physical problems and should be treated medically / physiologically

87
Q

basic assumption of the biochemical explanation?

A

assumed mental disorders have a physical cause and are a result of an imbalance in chemicals

88
Q

what are neurotransmitters?

A

the nerve cells of the brain use neurotransmitters which are chemical messengers

neurotransmitters are used by the nervous system to regulate many functions and processes in our bodies such as sleeping and metabolism

the messages the nerve cells send through synapses also play a role in
mood regulation

89
Q

how do synapses work?

A

neurons transfer info to each other via synapses.

this is a connection that allows one cell (pre-synaptic cell) to pass chemicals to another cell (post-synaptic cell)

the chemicals passing across the synaptic cleft/ gap are called neurotransmitters

chemicals cross this synapse and transmit an electrical signal. Once the post-synaptic cell has received chemical, it is taken back to the first pre-synaptic cell (called the REUPTAKE)

90
Q

what is the chemical
imbalance of depression (according to the biochemical explanation)?

A

serotonin is a neurotransmitter linked to mood, sleeping and eating

low serotonin is a chemical imbalance which has been linked to depression

SSRIs are drugs which block the reuptake so that serotonin reaches the post-synaptic cell and stays in the system longer

91
Q

evidence for the chemical imbalance that causes depression?

(a study)

A

in their study, the Duke researchers used a transgenic mouse strain (Tph2K1), bred to have only 20-40% of normal serotonin levels

the mice were exposed to stress by briefly housing them with an aggressive stranger mouse every day for 7-10 days. to test for depression-like behaviours, the researchers then examined whether the test mice would avoid interacting with stranger mouse.

The control mice did not exhibit these depression symptoms after a week of social stress, but the serotonin-deficient mice did.

both groups eventually displayed depression like symptoms following longer periods of stress exposure

the mice with depression like symptoms were treated with Prozac (an SSRI) for 3 weeks. Normal mice saw reduced depression symptoms following treatment, but the Tph2KI mice did not.

92
Q

what is the chemical imbalance of schizophrenia?

A

dopamine is a neurotransmitter linked to memory, reward and motivation

drugs can increase dopamine, so drug users can show symptoms of psychotic disorders

Dopamine Receptor Blockers block post-synaptic cells from receiving the dopamine to reduce psychotic symptoms

93
Q

what does SSRI mean?

A

selective serotonin reuptake inhibitors

94
Q

how do SSRIs work?

A

SSRIs block the reuptake process and therefore prevent the serotonin from being reabsorbed into the pre synaptic cell

this means that more serotonin is available in the synaptic gap to pass further messages between nearby cells and stimulate the post synaptic cell

SSRIs therefore alter the balance of serotonin levels in the brain

95
Q

is there any evidence to suggest anti depressants are effective at treating symptoms of depression?

A

Cipriano et al. (2018) reviewed research comprising over 522 trials and used over 116000 participants

all studies had looked for data 8 weeks into taking anti depressants or a placebo

the research found that all 21 types of anti depressants were more effective at treating depressive symptoms in adults compared to the placebo pill

the research did find that some anti depressants were
more effective than others

96
Q

strengths of using SSRIs to treat depression?

A

effectiveness demonstrated through Cipriani’s study

can be cheaper than therapy

97
Q

weaknesses of using SSRIs to treat depression?

A

dependence/addiction

side effects

linked to rise in suicidal thoughts

not immediate

expensive

individual differences

is it tackling the cause?

98
Q

what is the basic assumption of the genetic explanation?

A

it assumes disorders are a result of genes

as a result, disorders and the genes that cause them can be passed down parent to child and can be shared by siblings

99
Q

define genetic transfer

A

when a behaviour or characteristic is passed down from a parent to child. It is possible for 1 child to show a tendency or a disorder when another doesn’t

100
Q

what are monozygotic twins?

A

identical twins, same generic makeup

come from one shared egg, sharing 100% of genes

101
Q

what are dizygotic twins?

A

twins who are not identical

2 eggs, sharing up to 50% of genes

102
Q

why does research sometimes use monozygotic and dizygotic twins?

A

identical twins share 100% of their DNA. If traits are a result of genes, it would be expected that they would share these traits

in other words, if a trait is genetic it should affect both twins. to measure this, concordance rates are used. if something is concordant, it means that it is present in both twins

103
Q

aim of Gottesman?

A

to investigate the probability of a child being diagnosed with a mental disorder.

they did this by comparing when both parents have a disorder, one parent had a disorder or neither parent has a disorder

104
Q

sample of Gottesman?

A

more than 2.7 million people from Denmark

criteria = they had to have a registered link to their biological parents

also had to be born during or after 1968 and had to be aged 10+ on Jan 2007

105
Q

procedure of Gottesman?

A

people with a clear link to their parents were taken from the Danish Civil Registraion system.

researchers then used data from Psychotic Central Register to identify people with schizophrenia, bipolar or unipolar disorder

statistics were in the public domain and anonymous so no consent was needed

106
Q

findings of gottesman in group A (both parents had disorder)

A

27.3% had schizophrenia

24.9% had bipolar

107
Q

findings of Gottesman group B (one parent)

A

7% had schizophrenia

4.4% had bipolar

108
Q

findings of Gottesman Group C (neither parent)

A

0.86% had schizophrenia

0.48% had bipolar

109
Q

findings of gottesman Group D (general population)?

A

1.2% had schizophrenia

0.63% had bipolar

110
Q

conclusions of Gottesman?

A

the risk of schizophrenia was 31.7x higher when 2 parents had a diagnosis compared to neither parent

risk of bipolar was 51.9x higher when 2 parents had diagnosis compared to neither parent

suggests mental disorders such as schizophrenia and bipolar are genetic

111
Q

advantages of the genetic explanation of mental illness?

A

could predict disorders and give guidance on marriage/adoption (is this ethical?)

112
Q

disadvantages of the genetic explanation?

A

concordance rate isn’t 100% so no guarantee a child will develop the disorder

gottesman lacks validity as it only counts those admitted to the hospital

reductionist

113
Q

basic assumption of the brain abnormality explanation?

A

assumes mental disorders have a physical cause and are a result of abnormal brain structures

114
Q

how can we research the brain?

A

brain scans such as PET scans

post-mortems

115
Q

what is a PET scan?

A

Position Emission Tomography (PET) scans show which parts of the brain are active rather than just showing structure

blue = less active

red = more active

116
Q

what was Brown’s study?

A

1986

studied the brains of 41 participants with schizophrenia and 29 with an affective disorder

the brains of those with schizophrenia were 6% lighter than those with an affective disorder. they also had larger ventricles

disadvantage of the study was there is no control group to compare to

117
Q

what was weinburger’s study?

A

compared identical twins where one had a diagnosis of schizophrenia

MRI scans were used to compare the structures of the brains of 9 pairs of twins

a difference was found in the volume of the hippocampi and activity in the prefrontal cortex

118
Q

what did Strakowski do?

A

1999

studied 24 parents with a diagnosis of bipolar disorder

they found the amygdala was enlarged in those with a diagnosis of bipolar

the Amygdala is a region linked to memory, decision making and emotional responses

there were also differences in the prefrontal and hippocampal regions

119
Q

what did Sheline do? (1995)

A

compared hippocampi in elderly women

the hippocampus was smaller in those with depression than other women of the same age

Cortisol, a stress hormone, can destroy hippocampal cells. These cells usually respond to Serotonin.

120
Q

what did Baxter do? 1992

A

measured activity before and after treatment in regions of the brain for participants with OCD

changes in behaviour correlated with reduced activity in the right caudate nucleus which is linked to control and reward

activity in these areas reduced with both drug and behavioural theory

121
Q

advantages of the brain abnormality explanation?

A

scientific technology to identify abnormalities = objective

could help identify treatments

alleviates blame for individual

122
Q

disadvantages of the brain abnormality explanation?

A

reductionist

hard to narrow down the exact area of the brain

people may have abnormalities without showing symptoms

123
Q

basic assumption of the behaviourist explanation?

A

dysfunctional behaviour is learnt in the same way as any other behaviour through the processes of classical and operant conditioning and social learning

therefore suggests that mental illness is a result of nurture

124
Q

how can the Social Learning Theory explain mental illness?

A

assumes disorders are learnt through a process of observation and imitation

if a child has witnessed someone reacting to a challenge in an unhealthy, maladaptive or irrational way, they may learn it and adopt those behaviours

125
Q

how can operant conditioning explain mental illness?

A

assumes disorders are learnt though positive reinforcement, negative reinforcement and punishment

phobias may be learnt though negative reinforcement

avoidance will act as negative reinforcement. the removal of unpleasant symptoms leads the individual to repeat the avoidance behaviour

126
Q

how can classical conditioning explain mental illness

A

assumes disorders are learnt through association

if someone with agoraphobia had an embarrassing experience in a public place, they may associate that feeling with being in a public place

127
Q

aims of watson and rayner?

A

to see if it is possible to induce a fear of a previously un-feared object, through classical conditioning

to see if the fear will be transferred to other similar objects

to see what effect time will have on fear response

to see how possible it is to remove the fear response in the laboratory

128
Q

method of watson and rayner?

A

a case study undertaken on one little boy, Little Albert. It was conducted in controlled lab conditions

129
Q

participant of watson and rayner?

A

little albert was the child of a wet nurse, and so lived in a hospital environment.

he was described as stolid and emotional

130
Q

procedure and findings of watson and rayner?

A

when his baseline reactions were assessed before the controlled experiments began, Albert had no fear reactions to a rat, a rabbit, a dog, a monkey, a mask with hair or cotton wooo

Watson and rayner noted that ‘not the slightest sign of a fear response was obtained in any situation’

after repeated pairing with a loud noise, the fear brought about by the loud noise was enough to result in a phobia of the rat.

this fear then spread to other objects like a Father Christmas beard

131
Q

conclusion of Watson and Rayner?

A

phobias could be learnt through classical conditioning

132
Q

strengths of the behaviourist explanation of mental illness?

A

explains disorders that biology can’t eg phobias

an alternative to genetics for explaining why family members may share disorders

133
Q

weaknesses of the behaviourist explanation?

A

reductionist

deterministic, implies we have no choice in how we behave

individual differences, some people develop disorders without negative experiences

134
Q

what happens in flooding therapy?

A

based on the principles of classical conditioning

the aim is to expose the individual to their most feared situation

initial fear reaction will subside through exhaustion and the individual will feel calmer

this builds an association between the calm feeling and the original phobic stimuli

135
Q

what does flooding treat?

A

some types of specific phobia, for example, fear of heights

136
Q

what is aversion therapy?

A

based on principles of Classical Conditioning

the aim is to create an association between an unwanted behaviour and an unpleasant stimuli eg electric shocks

for example, emetics which react to alcohol may be given as part of rehabilitation

137
Q

ethical issues of aversion therapy?

A

deliberate pain and discomfort inflicted.

most notoriously used in the past to try to change sexuality of homosexuals and transvestites

138
Q

what is token therapy?

A

based on the principles of Operant Conditioning

tokens are given for desirable behaviours and they can be saved up for a reward

used in prisons eg tokens for being helpful to staff or showing commitment to rehabilitation can be used to purchase a TV in their cell or the ability to wear their own clothes.

139
Q

what disorders does token economy treat?

A

used to shape behaviour of patients in mental hospitals

140
Q

effectiveness of token economy

A

successful in socialising disturbed patients

can break down outside institutional setting

141
Q

what is systematic desensitisation?

A

based on classical conditioning

reaches the patient to associate a relaxed response to the fear stimulus instead of a fearful response

according to this strategy, two emotional states cannot exist at the same time so the relaxation should take over the fear

142
Q

what does systematic desensitisation involve?

A

patient and therapist make a fear hierarchy where they rank the patients fears from least to most feared

patient is taught relaxation techniques at each stage such as breathing techniques and muscle relaxation

once the patient feels comfortable ke with each stage, they move on to the next until desensitisation has become successful

143
Q

what did McGrath do (1990)?

A

used systematic desensitisation on a 10 year old called Lucy, who had a fear of loud noises

before treatment she rates her fear for balloons to be 7/10 and party poppers to be 9/10

she created a hierarchy of fears and worked through them over a 10 week period. her relaxation technique was to imagine she was playing with her toys at home

after the 10 weeks, her self rating for fear of balloons was 3/10 and for part poppers was 3/10

144
Q

strengths of systematic desensitisation to treat agoraphobia?

A

evidence shows behaviourism is effective

more ethical for use with children

no side effects

no dependency

145
Q

weaknesses of systematic desensitisation/ behaviourist methods to treat agoraphobia?

A

takes time to see results

flooding may be unethical

reductionist — may only change behaviour and not underlying thoughts

difficult if the patient is unwilling or unmotivated

146
Q

what is the assumption of the cognitive explanation for mental health?

A

assumes mental disorders are a result of faulty thought process

cognitive biases and negative self schemes may impact our mental health

147
Q

what did aaron beck do?

A

beck created the negative cognitive triad as a model of identifying the 3 main thoughts someone with depression may have

people with depression may have irrational cognitions about themselves and the world around them

THE SELF — the individual believes that they are worthless or have negative self concepts, eg they are unattractive or not likeable

THE FUTURE — the individual thinks the future is going to be negative, eg they might think they will never find the right partner or job

THE WORLD — the individual thinks everything is negative around them, such as people and situations

148
Q

what did albert ellis suggest?

A

some people with depression or anxiety may set high and sometimes unrealistic goals

the individual may feel like a failure if they cannot achieve these goals, eg ‘I must achieve all A*s’

149
Q

what is CBT?

A

cognitive behavioural therapy

is a talking therapy which aims to change the ‘faulty’ thought processes in the present (the therapy isn’t concerned with a patient’s past

the therapy teaches patients how to identify distorted cognitions to help them distinguish between their own thoughts and reality

150
Q

how effective is CBT?

A

a review conducted by Hofmann (2012) found that some studies had shown CBT was as effective as medication for treating depression

the research also found that CBT can provide immediate reduction of the symptoms of some anxiety disorders

151
Q

what are arbitrary inferences?

A

drawing negative conclusions off the back of insufficient evidence

eg ‘My partner must be cheating on me as they haven’t replied to my text’

152
Q

what is selective abstraction / thinking?

A

focusing on negative details or events whilst ignoring the positive ones

eg ‘I had a terrible day. I got soaked on my way to college, then realised I left my phone at home’

153
Q

what is overgeneralisation?

A

drawing sweeping conclusions based on a single incident

eg ‘I waved at my friend friend from the other side of the road. They ignored at me so they must be mad at me.’

154
Q

what is catastrophising?

A

exaggerating a minor setback until it becomes a complete disaster

eg ‘I might fail this test. Then I’ll never pass my A
LEVELS. Then I’ll never get a good job.

155
Q

what is black and white thinking?

A

seeing everything in terms of success or failure— nothing in between

eg ‘I’m a terrible person but my friend isn’t.’

156
Q

strengths of the cognitive explanation?

A

evidence that CBT is effective

deterministic

157
Q

weaknesses of the cognitive explanation?

A

reductionist

you have to fully engage with therapy for it to be effective

158
Q

what does the psychodynamic explanation of mental illness assume?

A

assumes mental disorders are a result of inner conflicts of the mind and repressed childhood experiences

159
Q

how does denial explain mental illness?

A

refusing to accept something traumatic has happened can lead to anxiety and depression if it is not dealt with at the time

160
Q

how does displacement explain mental illness?

A

moving your feelings about one thing onto another.

eg Hans displaced his father onto horses, leading to his fear of horses

161
Q

how does repression explain mental illness?

A

suppressing a thought so it remains in the unconscious can result in phobia and other disorders

eg Little Hans repressing his love for his mother led to a phobia of horses

162
Q

how can the psychodynamic theory explain anxiety and depression?

A

if the Ego gives into the Id then we may feel guilt from the Superego

this may lead an individual to feeling anxious or depressed

163
Q

how can the psychodynamic theory explain schizophrenia?

A

a weak Ego which can’t control the Id may lead to a loss of contact with reality

we could return to a child like state where imagination and reality become one distorted view of life.

164
Q

what is free association

A

a talking therapy

involves getting patients to talk out loud about a given topic

words are given for the patient to react to and these reactions are explored further

165
Q

what is dream analysis

A

a talking therapy

looks at the content of an individual’s dreams and interprets them as representations of real desires and the unconscious

the manifest content is the actual content of your dream, whilst the latent content is the meaning behind it.

166
Q

strengths of the psychodynamic explanation?

A

more holistic than other explanations

explains adult behaviour as a result of childhood experiences

somewhat deterministic and therefore behaviour is predictable

167
Q

weaknesses of the psychodynamic explanation?

A

not scientific and therefore not falsifiable

subjective

not easy to access a patient’s unconscious

does not work for all disorders

168
Q

how is Szasz useful?

A

raises awareness of labelling people with mental illness

exposes politicisation and medication of psychiatry

encourages treating voluntary patients only - useful for giving patients more choice

raises awareness that medication may have only suppress symptoms - highlights alternative treatments

calls for better defining of mental illness

raises awareness of over diagnosing and lowering of thresholds

169
Q

how is szasz not useful?

A

none of his points are supported by scientific evidence

socially sensitive - creates negative views of psychiatry and psychiatry

could be szasz be encouraging loss of trust in political power?

evidence suggests medical treatment can be effective. Trying to help patients understand themselves may not be enough to help them

170
Q

what were the four key themes of Szasz’s essay?

A

Szasz’s criticisms of using the medical model to explain and treat mental illness

mental illness is down to the judgement of others

political power and social control

the responsibility and freedom of individuals

171
Q

what is theme 1 of szasz?

A

if there is a physical cause, it is a physical illness and should be treated as a PHYSICAL illness.

if there is no physical cause, it is not an illness

172
Q

pro szasz– why mental illness should NOT be medicalised

A

could be argued that treating disturbances as medical events can lead to individuals being subject to state control eg sectioned

behaviours simply not approved of or understood by majority can be labelled as an illness when they are nothing more than a bit different from the norm

173
Q

anti szasz– mental illness should be medicalised

A

good think that disturbances have been medicalised as those experiencing them can feel reassured that their experience is not completely unusual

predictability of disorders can lead to treatment

174
Q

what is theme 2 of szasz

A

mental illness is a subjective concept determined by the judgement of a few people

175
Q

pro szasz: mental illness is down to the judgement of others

A

judgements can vary over time or between cultures therefore could be seen as a social culture

APA + WHO judge mental health and these manuals are constantly changing

mental illness can be seen as a subjective concept, especially if it cannot be measured

176
Q

what are the cons of szasz’s view that mental illness is down to the judgement of others

A

socially sensitive

acknowledgement of mental illness can lead to access to further support

there are examples of disturbances in mental health which would elicit concern in any location at any time

people could lose trust in the mental health sector

177
Q

pros of szasz’s view that mental illness is constructed by political powers and social control

A

creation of new labels of mental health conditions is in the pharmaceutical industry’s financial interest which contributes to government money

labels can lead to social control causing patients not being able to make their own decisions

178
Q

cons of szasz view that mental illness is a construct made for political powers/ social control

A

individuals suffering with mental health issues feel understood by people in power

179
Q

pros of szasz view that patients should be listened to and understood and should have a choice

A

freedom is a basic human right

encourages treating voluntary patients only– useful for patients who do want more freedom and choice

180
Q

cons of szasz view that patients should be listened to and should have a choice

A

sectioning can be in best interest if they are a danger to themselves or others

some individuals do not have the mental capacity to make appropriate decisions about the treatments they should receive

181
Q
A