mental health Flashcards
how is a mental disorder defined?
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
what was trepanning?
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
what were the Old Testament / Early Judaism’s views on mental health?
‘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
how did Early Civilisations (eg Chinese and Egyptian) view mental illness?
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
what was the view of mental illness in Ancient Greece in Homer’s era? (800-700BC)
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
what was Hippocrates’ view of mental illness?
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
what was Ancient Rome / Cicero’s view on mental illness?
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
what was Christianity’s view of mental illness? (around 300AD)
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
what was the view of mental health in the middle ages?
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
what were the Enlightenment Thinkers’ views on mental health?
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
what was Freud’s view of mental illness?
mental illness is a result of the unconscious mind.
Typical causes = trauma or issues during development. Could be treated through psychoanalysis
what is electroconvulsive therapy?
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
what are lobotomies?
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
what is the biopsychosocial model?
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.
what is the definition for abnormality regarding statistical infrequency?
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.
what are the advantages of the ‘statistical infrequency’ definition?
- objective, based solely on frequency of occurrence so no bias
- easy to calculate and therefore easy to identify abnormality
disadvantages of the statistical infrequency definition for abnormality?
- 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
what is the deviation from social norms definition for abnormality?
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
how does culture influence what is deemed abnormal by society?
norms are ethnocentric, eg in India, Schizophrenia is thouhjt to be caused by the possession of evil spirits
how does situation and context influence what is deemed to be abnormal by society?
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
how does age influence what is deemed normal by society
having a tantrum at
age 2 is normal but having a tantrum at age 16 is not
how does gender influence what is deemed as normal by society?
there are gender stereotypes, eg a male not crying, or females being nurturing and motherly. but these don’t necessarily make people normal/abnormal
how does historical context influence what is deemed as abnormal?
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’
advantages of the deviation of social norms definition for abnormality?
means it is potentially easy to identify (see) someone who is behaving in an abnormal manner
disadvantages of the deviation of social norms definition for abnormality?
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.
examples of cultural relativism?
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
what is the failure to function adequately definition for abnormality?
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:
- Dysfunctional behaviour - is the behaviour maladaptive?
- Personal Distress - is the individual experiencing the behaviour distressed?
- Observer discomfort - are other people affected by the behaviour?
4.Unpredictable behaviour - is the behaviour unexpected in that situation?
- Irrational behaviour - does the behaviour make sense in that situation?
advantages of the failure to function adequately definition?
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
disadvantages of the failure to function adequately definition?
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
what is the deviation from Ideal Mental Health definition?
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
what was ideal mental health according to Marie Jahoda (1958)?
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
advantages of the deviation from ideal mental health definition?
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
disadvantages of the deviation from ideal mental health definition
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
what does it mean to categorise mental disorders?
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
what two categorisation tools are used?
the DSM V and the ICD
what do the categorisation tools do?
both the ICD and the DSM comprise of a list of all recognised mental health conditions with symptoms which indicate a particular disorder
what do the categorisation tools not do/offer?
they do not offer explanations for disorders or suggestions for treatments
what is the main purpose of the categorisation tools?
by having a list of symptoms used by all professionals, the reliability of diagnosis should be improved
who is the DSM published by?
the American Psychiatric Association
what is the DSM?
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
what is the ICD?
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
what are two ways that the DSM has changed over time?
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
advantages of the categorisation tools?
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
disadvantage of the categorisation tools: is human behaviour too complex?
diagnostic tools can oversimplify complex behaviour
there is an argument that manuals are reductionist
disadvantage of categorisation tools: is there a risk of over diagnosis?
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
disadvantage of the categorisation tools: are big pharmaceutical companies too involved in categorisation?
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
disadvantage of the categorisation tools: what about the treatment of disorders?
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
is the categorisation/ diagnosis of mental disorders valid?
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
is the categorisation/diagnosis of mental disorders reliable?
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
is there an issue of ethnocentrism with categorisation?
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
how can diagnosis cause labelling and stigmatisation?
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
how can changing social norms be seen as a problem with categorisation?
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
what was the overall aim of Rosenhan?
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
what was rosenhan exp1 procedure?
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
who were the participants in Rosenhan Exp1?
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
results of rosenhan 1?
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
what were the comments from the other patients in rosenhan 1?(and how many people voiced their suspicions?)
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’
what was noted about the queueing behaviour in rosenhan1?
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
what was said about writing behaviour in rosenhan 1?
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
why did these results happen in the first experiment of rosenhan?
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
what was Rosenhan Exp2?
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
results of rosenhan 2?
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
conclusion from rosenhan 2?
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?
in rosenhan, what was the experience like in the psychiatric hospitals?
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
what is the stickiness of labels (rosenhan)
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
powerlessness demonstrated in Rosenhan?
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
depersonalisation shown through rosenhan?
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
what was rosenhan exp3?
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
findings of rosenhan 3?
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
what are the consequences of labelling and depersonalisation?
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
conclusions of Rosenhan’s study?
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
what is an affective disorder + example?
disorders characterised by disordered mood
eg depression
