Mental Illness and its critics Flashcards
What is Sargent’s and Slater’s approach to mental illness?
How does Eliot Slater (1954) define their approach towards mental illness?
What place did the Sargent’s and Slater’s text book have in the postwar period?
“The main claim of the physical approach, that is the assumption that mental disorders are dependent on physiological changes, is that it is a useful working hypothesis. It has made great advances and looks like making more” (Sargent and Slater, 1954)
- their textbook was the dominant book of postwar years
What is Peter Tyrer’s (1998) definition of mental illness?
What does it imply?
“The name ‘mental illness’ implies disease.
An illness suggests something wrong that is fundamentally different from normal function and is not just a variation in degree…”
-> some mentally ill people are fundamentally different
How can you make a psychiatric diagnosis using the DSM, with the example of alcohol intoxication?
Alcohol intoxication (DSM):
A- Recent ingestion of alcohol
-> Have I had a drink?
B- Problematic or psychological changes (e.g. impaired judgement)
-> Has the drink led to a problem
C- Symptoms: slurred speech, incoordination, nystagmus (eyes move rapidly by themselves), impairment of attention or memory, stupor, coma
-> Have I experienced a specified number of symptoms? (in this case just one is required)
D- Symptoms are not attributable to another medical condition and are not better explained by another mental disorder (including intoxication of other substances)
-> Is there an exclusion? - Was I merely ‘tired and emotional’?
What use is the DSM-5 codes for various mental disorders?
DSM-5 codes are for administrative purposes.
- the code for uncomplicated intoxication is F10.929
≠ legal definitions for ‘drink driving’ which is based on blood levels
What were and are the different critical view points of the mental illness construct?
- Sociologists such as Goffman and Scheff
- The perspective of the user (The Alleged Lunatic’s Friend Society, 1845-1863 onwards)
- Antipsychiatrists, Critical Psychiatrists and now Postpsychiatrists
- Opponents of ‘Big Pharma’
- Proponents of psychological approaches to mental distress
- the Recovery Movement
What is the Alleged Lunatic’s Friend Society?
How does there 1846 pamphlet reflect the perspective of the user?
Early 19th Century,
- Richard Paternoster was detained in a madhouse
- After he was discharged, he was contacted by John Perceval (son of assassinated Prime Minister Spencer Perceval) who had also been confined in 2 private asylums
- > formation of the Alleged Lunatic’s Friend Society
- Key members were patients who had experienced madhouses, asylums
- Members were also relatives and interested public figures (including lawyers and MP’s)
- The Society used Parliament, Government, the legal system, the press, public lectures and meetings to influence change
ALFS 1846 pamphlet:
“formed for the protection of the British subject from unjust confinement, on the grounds of mental derangement, and for the redress of persons so confined; Also for the protection of all persons confined as lunatic patients from cruel and improper treatment.[…]”
What was the Antipsychiatry movement?
Who led it and what this figure’s idea of mental illness?
Antipsychiatry (originated in the 1960’s)
- libertarians / Existentialist perspective
Thomas Szasz - ‘The Myth of Mental Illness’ (1961)
- 1998 manifesto:
“Mental illness is a metaphor (metaphorical disease).
[…] The term […] refers to the undesirable thoughts, feelings, and behaviors of persons. Classifying thoughts, feelings, and behaviors as diseases is a logical and semantic error, like classifying the whale as a fish. As the whale is not a fish, mental illness is not a disease.
[…] The classification of (mis)behavior as illness provides an ideological justification for state-sponsored social control as medical treatment.”
What was the Critical Psychiatry movement?
Which figure led that movement?
Critical Psychiatry (originated in the 1970’s)
- Left-wing / Marxist perspective
- David Ingleby ‘Critical Psychiatry’ (1981)
What is R. D. Laing’s idea of madness, as described in ‘The politics of Experience’ (1967)?
What was his influence?
How can he be characterised?
‘The Politics of Experience’ (1967) - R. D. Laing
“Madness need not be all breakdown. It may also be breakthrough. It is potential liberation and renewal as well as enslavement and existential death.”
- he’s been extremely influential on a generation of psychiatrists
- an “Existential Psychiatrist”
Who were the founders of the Critical Psychiatry Network (CPN)?
What were its concerns for the psychiatric practice, as described in their manifesto?
Laing and Szasz
- Building on the ideas of the so-called antipsychiatrists
- organised movement, website
Manifesto -> concerns:
- psychiatry that is heavily dependent on diagnostic classification and psychopharmacology
- recognition of poor construct validity of psychiatric diagnoses
- skepticism about the efficacy of psychiatric drugs (antidepressants, mood stabilisers, antipsychotic agents)
- the use of psychiatric diagnosis to justify civil detention, and the role of scientific knowledge in psychiatry
- interest in promoting the study of interpersonal phenomena
(e. g. relationship, meaning, and narrative) in a pursuit of better understanding and improved treatment
What is Postpsychiatry?
What are two figures of this movement?
- ‘Postpsychiatry: mental health in a postmodern world’ (Patrick Bracken, Philip Thomas)
- Informed by philosophy (e.g. postmodernism)
- Emphasis on hermeneutics:
“Human reality is something open, full of potential and unyielding to formulae or models. Meaning cannot be fixed. Central to hermeneutics is context”
(Postpsychiatry, 2005)
-> not obviously conducive to care planning
How to the opponents of ‘Big Pharma’ view Psychiatry, the Medical Model in relation to ‘Big Pharma’?
What is the ‘Big Pharma’ business model?
What do these opponents criticise?
Which figure is known as opposed to ‘Big Pharma’?
> Psychiatry and ‘Big Pharma’ are thought as one:
- “it’s doubtful either one of you would survive alone” (Adams)
The Medical Model is criticised for being dependant on the pharmacological industry
‘Big Pharma’ business model: innovative treatments for common and long-term conditions (= “holy grail”)
They criticise:
- suppression of negative studies (e.g. on the efficacy f anti-depressants)
- encouragement of new disorders and over-diagnoses
(e.g. paediatric bipolar disorder -> young people treated with large quantities of potentially toxic medication ;
ADHD -> an “ideal disorder’ for ‘Big Pharma’: chronic, long-term and responds to pharmacological interventions)
(these diagnoses exposed in America)
Peter Kinderman (2014)
What does Peter Kinderman present in ‘A prescription for Psychiatry’ (2014)?
Why are his view very attractive?
What could indicate that he might be setting up false antitheses?
Peter Kinderman - ‘A prescription for Psychiatry’ (2014)
- a psychological prescription
- he is a member of the British Psychological Society (BPS)
- rejects psychiatric diagnostic classificatory systems
- “a manifesto for an entirely new approach to psychiatric care; […] a return to the common sense appreciation that distress is usually an understandable reaction to life’s challenges.”
- attractive views: empirical evidence suggests people prefer care to coercion and therapy to medication
BUT, false antitheses?
- he rejects diagnosis in favour to ‘formulation’ even though ‘formulation-based’ psychological therapies are based on diagnosis-equivalent constructs
(e. g. ‘psychosis’, ‘anxiety’, ‘delusions’)
What arguments can be made to counter the criticisms towards mental illness?
> ‘Illness’ language seems highly appropriate to some forms of mental disorder
- acute psychotic episodes, acutely manic person, severe obsessive compulsive disorder
Differences between mental and physical illnesses might have been exaggerated by Thomas Szasz
There’s positive value in diagnosis as ‘an agenda for action’
‘diagnosis’ has a specific meaning and shoudn’t be over-interpreted
- it’s a “statement that a person’s presentation or problems meet certain criteria”
What is Dr Frank Holloway’s personal toolkit to understanding mental disorder?
- Nosology: DSM-5 (latest attempt to understanding mental disorder)
- Descriptive psychopathology
- “describes and categories the abnormal experience as recounted by the patient and observed” (Slims, 2003) - Phenomenology
- “the philosophical study of the structure of experience and consciousness”
- in practice: allow to “look, in a structured way, at the experience and behaviors of a person”
