Mental Health topic 1 - historical context

Question 1

What are the two types of historical explanations for mental health, and which examples are associated with these?

Answer 1

Supernatural explanation - Demonic possession
Somatogenic explanation - Humorism, Animalism

Question 2

Outline the theory behind demonic possession

Answer 2

In pre-modern societies, one of the most common explanations of madness was that evil spirits had taken possession of an individual and controlled them. A spirit could enter a person through their own sunning, the work of an evil doer or with magical powers or a lack of faith from the possessed individual.

Question 3

What was the treatment for demonic possession?

Answer 3

Trepanning - some cave dwellers have been found with characteristic holes

Question 4

Outline Humourism

Answer 4

Mental health issues are a result in the imbalance of the four humours; black bile, yellow bile, Phlegm and blood
For example, if someone was sluggish and dull. the body supposedly contained a preponderance of phlegm.

Question 5

Outline the theory of animalism

Answer 5

The only thing that differentiated humans from animals was their ability to reason, so when people were ‘mad’ they had lost that ability and therefore should be treated as animals

Question 6

Outline moral treatment in terms of the history of mental illness

Answer 6

Phillippe Pinel in 1792 tried to improve mental health treatment by removing the chains and allowing the patients time outside exercising. Because of the success of this, this was mut into practice in many different plaxwa

Question 7

Define statistical infrequency

Answer 7

If behaviour is common then its normal, but if it is rare then it is identified as abnormal

Question 8

What are the problems with using statistical infrequency to define abnormality

Answer 8

What if something is rare but is wrong to refer to as abnormal, e.g. some with a really high IQ might not necessarily be mentally ill

Question 9

Outline failure to function adequately as a definition of abnormality

Answer 9

If someone is unable to live in a ‘normal’ life. Defined by Rosenhan and seligman as being able to hold down a job, maintain a relationship, look after themselves and interact in society efficiently

Question 10

Outline the problems of failure to function adequately as a definition of abnormality

Answer 10

Inability to do this does not necessarily mean they are mentally ill. This is still a fairly subjective term

Question 11

Outline deviation from social norms as a definition of abnormality

Answer 11

Every society has norms for behaviour - they are maintained through laws, guidelines and social pressure
a person who doesn’t abide by the social norms may be considered abnormal

Question 12

Outline the problems with deviation from social norms as a definition of abnormality

Answer 12

Sometimes behaviour ma be a result of other factors e.g. choice or circumstances, like lack of education might be the reason for not getting a job, not a mental illness

Question 13

Outline deviation from ideal mental health as a definition of abnormality

Answer 13

Feeling positive about yourself and being able to grow psychologically
having self-discipline and being able to act independently
Having an accurate perception of reality and coping with the demands of that reality
Having positive social interactions with friends and family

Question 14

Outline the problems with deviation from ideal mental health as a definition of abnormality

Answer 14

Pretty much nobody fts into this criteria - who had ‘ideal mental health’?

Question 15

very briefly outline the DSM-5

Answer 15

22 categories of mental disorders e.g. depressive disorders, anxiety disorders, substance related and addictive disorders

Question 16

How are the disorders clustered together in the DSM-5?

Answer 16

Internalising disorders together (e.g. depression and anxiety)
externalising disorders together (e.g. substance abuse)

Question 17

How is the DSM-5 organised?

Answer 17

on developmental and lifespan considerations - begins with developmental processes, followed by diagnoses associated with adolescence and young adulthood, and ends with diagnoses relevant to adulthood and later life

Question 18

What are 5 other issues addressed in the DSM-5?

Answer 18

gender related diagnostic issues
culture-related diagnostic issues
co-morbidity - which disorders frequently occur together
prevalence - e.g. frequency within different age groups
diagnostic criteria such as specific symptoms a patient had to show.

Question 19

what are three examples of categories in the DSM-5?

Answer 19

sexual dysfunctions
gender dysphoria
feeding and eating disorders

Question 20

How could categorising disorders be ethnocentric?

Answer 20

Different cultures use different classification systems
some behaviours may need to be seen in the context of the culture to make sense

Question 21

How could categorising disorders not be ethnocentric?

Answer 21

the DSM-5 includes information on culture related diagnostic issues
Some conditions occur everywhere and the symptoms are likely to be the same
In practice more practitioners are using both the DSM-5 and ICD

Question 22

How might categorising disorders be useful?

Answer 22

These tools may be a useful starting point to identify a disorder
Makes it easier to diagnose consistently

Question 23

How might categorising disorders not be useful?

Answer 23

do not offer explanations or treatments
Rosenhan argues a rigid classification actually increases the suffering of those with a mental health diagnosis as it labels them and removes their control of the situation
may be influenced by pharma companies - Krimsky and Cosgrove found 69% paid workers on DSM-5 had links with pharma

Question 24

How might categorising disorders be reliable?

Answer 24

Each disorder uses a set of clear criteria to follow
researchers have been involved in creating the DSM and agreed upon the definition
Revisions have allowed clearer criteria

Question 25

How might categorising disorders not be reliable?

Answer 25

Subjective
symptoms of a mental disorder not as clear as with a physical
lack of agreement across psychiatrists in USA and UK
Differences relating to gender, culture and the fact that some symptoms overlap means the diagnosis will not always be consistent

Question 26

How might categorising disorders be valid?

Answer 26

DSM-5 regularly updated e.g. homosexuality once considered a disorder
Some treatments work - means diagnosis was correct

Question 27

How might categorising disorders not be valid?

Answer 27

issues as most of the disorders have no known physical cause
tendency to over diagnose, so pharmaceutical companies can sell more medication
Diagnostic tools could be used subjectively
Ford and Widiger found that presenting the same symptoms to practitioners but changing the gender resulted in different diagnoses
Reliant on observation of people’s behaviours or interviews with them and reports from family members

Question 28

How might defining abnormality be ethnocentric?

Answer 28

social norms - abnormal to one society is not abnormal to another e.g. hearing voices
Ability to function - may vary from culture to culture e.g. in terms of standards of lifestyle

Question 29

How might defining abnormality not be useful?

Answer 29

statistical infrequency - someone with high IQ may be very happy and able to function but labelled as abnormal
Is sometimes acceptable to break social norms so difficult to judge if someone is abnormal from this definition
may not actually be useful to help diagnose or treat patients

Question 30

How might defining abnormality be useful?

Answer 30

if these 4 definitions were combined, they could be used as a theoretical framework

Question 31

How might defining abnormality not be reliable?

Answer 31

social norms - these change over time across cultures and can sometimes be acceptable to break them to hard to judge consistency
Ideal mental health - can be vague and difficult to quantify - hard to measure consistency
function - subjective definition - relative to your peers?

Question 32

How might defining abnormality be reliable?

Answer 32

statistical infrequency - data collected in a reliable way

Question 33

How might defining abnormality not be valid?

Answer 33

statistical infrequency - many behaviours may be rare but not seen as abnormal
Ideal mental health - who has that? - most people would not meet the criteria
Function - how do we decide what counts as functioning adequately?
Social norms - definition works for someone with a disorder such as OCD but may also be due to other factors such as fashion/choice.

Question 34

What was the aim of Rosenhan’s research?

Answer 34

to see if mental hospitals in the USA in the early 1970s could tell the sane from the insane

Question 35

What was the procedure of Rosenhan’s first study (not the experiment within it)?

Answer 35

8 sane people phones for an appointment at 12 different mental hospitals
When they arrived, they all reported hearing an unfamiliar voice of the same sex saying ‘empty’ ‘hollow’ and ‘thud’. Once admitted they stopped simulating any symptoms and took part in regular ward activities, while making notes about ward staff and patients (the participants)

Question 36

What were the pseudopatients in Rosenhan’s study admitted with, what were they discharged with and how long did they stay for?

Answer 36

11 times with schizophrenia and once with manic-depressive psychosis
schizophrenia in remission
They stayed for 7 to 52 days (average 19 days)

Question 37

Outline the treatment of the hospital staff towards the normal patients in Rosenhan’s study

Answer 37

patient records could be viewed by anyone
Some ward orderlies acted brutally to patients in full view of other patients but stopped when another member of staff approached
Attendants only spent 11.3% of their shifts outside ‘the cage’
Total time a patient spent with psychologists, psychiatrists ect was 6.8 minutes a day on average

Question 38

What was the reaction of the staff and patients to the pseudo patients in Rosenhan’s study?

Answer 38

Sanity not detected by staff - normal behaviours misinterpreted due to label (e.g. note taking seen as a symptom of disorder
35 of the 118 patients voiced suspicions (e.g. you’re not crazy’, ‘you’re a journalist or a professor’, ‘you’re checking up on the hospital’)

Question 39

Outline the procedure of the experiment within study 1 of Rosenhan’s study

Answer 39

in four of the hospitals, the pseudopatients approached a staff member with a simpe polite request (e.g. ‘excuse me, Mr/Mrs/Dr X, could you tell me when I will be presented at the staff meeting?’)
They recorded how staff responded to this request

Question 40

Outline the comparison study done at Stanford University for the experiment within study 1 of Rosenhan’s study

Answer 40

young female approached a member of staff who looked busy and asked them 6 questions including ‘ how does one apply for admission to the college?’

Question 41

Outline the comparison study done at a University medical centre for the experiment within study 1 of Rosenhan’s study

Answer 41

young female saying (amongst 6 questions that she had to ask) either ‘i’m looking for a psychiatrist’ or ‘i’m looking for an internist’

Question 42

Outline the procedure of Rosenhan’s second study

Answer 42

a hospital was informed that during the next three months one or more pseudopatients would attempt to be admitted into the hospital
Each member of staff was asked to rate each new patient on a 10-point scale as to the likelihood of them being a pseudopatient
No pseudopatients actually attempted to be admitted

Question 43

What were the results of Rosenhan’s second study?

Answer 43

Patients judged - 193
Patients confidently judged as pseudopatients by at least one member of staff - 41
Patients confidently judged as pseudopatients by at least one psychiatrist - 23
Patients confidently judged as pseudopatients by both - 19

Question 44

What were Rosenhan’s conclusions?

Answer 44

Mental hospitals in the USA in the early 1970s were not good at making valid or reliable diagnoses
They tended to view all behaviours as reflecting the diagnosis a patient had been given
Patients in mental hospitals were treated with profound disrespect

Question 45

In the psychiatric hospitals what percentages of Psychiatrists moved on with their head averted vs stopping and talking for Rosenhan’s first experiment?

Answer 45

moved on - 71%
stopped and talked - 4%

Question 46

In stanford university what percentages of staff members moved on with their head averted vs stopping and talking for Rosenhan’s first experiment?

Answer 46

moved on - 0%
stopped and talked 100%

Question 47

In stanford university what percentages of staff members moved on with their head averted vs stopping and talking for Rosenhan’s first experiment?

Answer 47

moved on - 0%
stopped and talked 78%

Question 48

Outline how Rosenhan’s study links to ethnocentrism

Answer 48

does cover hospitals over 5 states
but all in US so may not reflect patients in other cultures
other cultures may place more emphasis on other types of treatment

Question 49

Outline how Rosenhan’s study links to validity

Answer 49

lower population validity as can’t be generalised to american culture
very high ecological validity - covert participant observation
construct validity - comparison studies
researcher bias - possible they were biased in their interpretation
Not really experiencing mental illness so their experiences may not reflect those of real patients

Question 50

Outline how Rosenhan’s study links to usefulness of research

Answer 50

caused nation-wide reform to psychiatric system in US
Highlighted the awareness of the problem with labelling
but Now much more difficult to get a diagnosis
However, undermined the reputation of psychology

Question 51

Outline how Rosenhan’s study links to ethics

Answer 51

consent not gained from staff or patients in study 1
Deception - staff thought patients actually ill
Protection from harm - staff thought there were false patients in study 2 - study 1 patients may have felt uncomfortable thinking there was a journalist - staff might feel ashamed
Can’t withdraw when they don’t know a study is taking place
But ethically worthy - improving the lives of the patients and improve the system

Question 52

Outline how Rosenhan’s study links to reliability

Answer 52

not necessarily consisyent as they couldn’t control their behaviour the whole time
Procedure for admission standardised
impossible to replicate this study as the diagnostic system changed

Question 53

Outline how Rosenhan’s study links to individual/situational explanations

Answer 53

situational - the behaviour and label affected the way that their behaviour was interpreted by staff and therefore how they were treated
the way staff acted was an institutional practice

Question 54

How do the characteristics of disorders link to usefulness?

Answer 54

useful as can lead to diagnosis which could lead to treatment
can help other people understand someone’s symptoms
But may not be useful if it leads to labelling and discrimination and if the labels are subjective

Question 55

How do the characteristics of disorders link to ethnocentrism?

Answer 55

disorders diagnosed differently depending on which classification system is used (different in different countries)
Symptoms may be interpreted differently in different cultures e.g. hearing voices may be schizophrenia or a religious experience

Question 56

How do the characteristics of disorders link to socially sensitive research?

Answer 56

socially sensitive to say someone’s fear is irrational
labels still have negative implications - stigma around mental illness
Bad treatment of people with mental health problems

Question 57

How do the characteristics of disorders link to reliability?

Answer 57

clear diagnostic criteria gives consistency in how it is applied
Can’t be replicated as subjective bias which can undermine diagnosis - Kirkbride (2012) - black males diagnosed more often with Schizophrenia than white males

Question 58

What are the characteristics of Agoraphobia?

Answer 58

marked fear or anxiety about two or more of these situations:
Using public transport
being in enclosed spaces
Staning in line
being in a crowd
being in open spaced
being outside of the home alone
These situations almost always provoke an anxiety attack, the fear is out of proportion to the danger
The fear/avoidance persists for more than six months and causes significant distress and impairment of normal function

Question 59

Outline the characteristics of Schizophrenia

Answer 59

Two or more active symptoms in one month; at least one must be symptom 1,2 or 3
1. delusions
2. hallucinations
3. Disorganised speech
4. grossly disorganised or catatonic behaviour
5. negative symptoms such as diminished emotional expression
This disturbance should persist for six months, even if t minor labels, and there should be no other causes such as other disorders or substances

Question 60

Outline the characteristics of Depression

Answer 60

5 or more symptoms present during the same 2 week period including 1 or 2
1. depressed mood
2. marked diminished interest or pleasure in activities
3. body weight loss of more than 5% not due to diet or change in appetite
4. insomnia or excessive sleep
5. restlessness or less activity
6. fatigue or loss of energy
7. feelings or worthlessness or inappropriate guilt
8. lack of ability to think, concentrate or make decisions
9. recurrent thoughts or death or suicide
Should not be attributable to any other cause and must cause clinically significantly distress

Question 61

Define psychosis

Answer 61

when an individual loses touch with reality

Question 62

what are the Strengths of patient being required to display the listed characteristics in the diagnostic process

Answer 62

validity - based on asking patient themselves - self-report
Attempt to be holistic - if symptoms don’t have a negative effect on the normal functioning, a diagnosis should not be made
Reliability - same symptoms listed for disorders and some of the disturbances need to have persisted for 6 months

Question 63

Weaknesses of patient being required to display the listed characteristics in the diagnostic process

Answer 63

validity - may be bias or misunderstanding on the part of the doctor
validity/reliability - subjectivity involved
Validity - there may be other reasons for the symptoms that a patient does not know/disclose