Mental Health topic 1 - historical context Flashcards
What are the two types of historical explanations for mental health, and which examples are associated with these?
Supernatural explanation - Demonic possession
Somatogenic explanation - Humorism, Animalism
Outline the theory behind demonic possession
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.
What was the treatment for demonic possession?
Trepanning - some cave dwellers have been found with characteristic holes
Outline Humourism
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.
Outline the theory of animalism
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
Outline moral treatment in terms of the history of mental illness
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
Define statistical infrequency
If behaviour is common then its normal, but if it is rare then it is identified as abnormal
What are the problems with using statistical infrequency to define abnormality
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
Outline failure to function adequately as a definition of abnormality
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
Outline the problems of failure to function adequately as a definition of abnormality
Inability to do this does not necessarily mean they are mentally ill. This is still a fairly subjective term
Outline deviation from social norms as a definition of abnormality
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
Outline the problems with deviation from social norms as a definition of abnormality
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
Outline deviation from ideal mental health as a definition of abnormality
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
Outline the problems with deviation from ideal mental health as a definition of abnormality
Pretty much nobody fts into this criteria - who had ‘ideal mental health’?
very briefly outline the DSM-5
22 categories of mental disorders e.g. depressive disorders, anxiety disorders, substance related and addictive disorders
How are the disorders clustered together in the DSM-5?
Internalising disorders together (e.g. depression and anxiety)
externalising disorders together (e.g. substance abuse)
How is the DSM-5 organised?
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
What are 5 other issues addressed in the DSM-5?
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.
what are three examples of categories in the DSM-5?
sexual dysfunctions
gender dysphoria
feeding and eating disorders
How could categorising disorders be ethnocentric?
Different cultures use different classification systems
some behaviours may need to be seen in the context of the culture to make sense
How could categorising disorders not be ethnocentric?
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
How might categorising disorders be useful?
These tools may be a useful starting point to identify a disorder
Makes it easier to diagnose consistently
How might categorising disorders not be useful?
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
How might categorising disorders be reliable?
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
How might categorising disorders not be reliable?
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
How might categorising disorders be valid?
DSM-5 regularly updated e.g. homosexuality once considered a disorder
Some treatments work - means diagnosis was correct
How might categorising disorders not be valid?
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
How might defining abnormality be ethnocentric?
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
How might defining abnormality not be useful?
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
How might defining abnormality be useful?
if these 4 definitions were combined, they could be used as a theoretical framework
How might defining abnormality not be reliable?
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?
How might defining abnormality be reliable?
statistical infrequency - data collected in a reliable way
How might defining abnormality not be valid?
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.
What was the aim of Rosenhan’s research?
to see if mental hospitals in the USA in the early 1970s could tell the sane from the insane
What was the procedure of Rosenhan’s first study (not the experiment within it)?
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)
What were the pseudopatients in Rosenhan’s study admitted with, what were they discharged with and how long did they stay for?
11 times with schizophrenia and once with manic-depressive psychosis
schizophrenia in remission
They stayed for 7 to 52 days (average 19 days)
Outline the treatment of the hospital staff towards the normal patients in Rosenhan’s study
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
What was the reaction of the staff and patients to the pseudo patients in Rosenhan’s study?
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’)
Outline the procedure of the experiment within study 1 of Rosenhan’s study
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
Outline the comparison study done at Stanford University for the experiment within study 1 of Rosenhan’s study
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?’
Outline the comparison study done at a University medical centre for the experiment within study 1 of Rosenhan’s study
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’
Outline the procedure of Rosenhan’s second study
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
What were the results of Rosenhan’s second study?
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
What were Rosenhan’s conclusions?
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
In the psychiatric hospitals what percentages of Psychiatrists moved on with their head averted vs stopping and talking for Rosenhan’s first experiment?
moved on - 71%
stopped and talked - 4%
In stanford university what percentages of staff members moved on with their head averted vs stopping and talking for Rosenhan’s first experiment?
moved on - 0%
stopped and talked 100%
In stanford university what percentages of staff members moved on with their head averted vs stopping and talking for Rosenhan’s first experiment?
moved on - 0%
stopped and talked 78%
Outline how Rosenhan’s study links to ethnocentrism
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
Outline how Rosenhan’s study links to validity
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
Outline how Rosenhan’s study links to usefulness of research
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
Outline how Rosenhan’s study links to ethics
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
Outline how Rosenhan’s study links to reliability
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
Outline how Rosenhan’s study links to individual/situational explanations
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
How do the characteristics of disorders link to usefulness?
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
How do the characteristics of disorders link to ethnocentrism?
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
How do the characteristics of disorders link to socially sensitive research?
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
How do the characteristics of disorders link to reliability?
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
What are the characteristics of Agoraphobia?
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
Outline the characteristics of Schizophrenia
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
Outline the characteristics of Depression
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
Define psychosis
when an individual loses touch with reality
what are the Strengths of patient being required to display the listed characteristics in the diagnostic process
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
Weaknesses of patient being required to display the listed characteristics in the diagnostic process
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
