Midterm 1 Flashcards
Psychiatry before the 18th
Responsibility of the family
Help of religious order
Often exiled or jailed
Psychiatry during the 18th
Mental hospitals spread as a means of control
The great confinement
The insane as objects of bizarre curiosity
Psychiatry in the 19th century
Some reform of institutions
Religious people took in mentally i’ll people and gave them tasks
Humanity enters into the equation
Institutionalization
1800-1955
Total institutions
Often misused for deviants
Treatments like lobotomies, insulin comas and ECT
20th Century psychiatry
Freud - put everyone on a spectrum
Pharmaceutical intervention –> revolutionary
Deinstitutionalization and community psychiatry
Causes of deinsitutionalisation
- Development of anti-psychotic drugs
- Philosophical changes (60s liberation movement)
- Legal changes
- Economic changes (hospitals expensive - sold)
Mental disorder used
for diagnostics
Mental health used
like “well being” can have MI with good MH
“Mental disease” is
Archaic and rarely used
Madness, lunacy, and insanity
Used to label behaviour commonly considered extremely bizarre and disruptive
Influence of Freud
- he said lots of people experienced “neuroticisms” (different from madness)
- He believed in mental illness as a continuous variable not a categorical one
- Blurred the line between normal and abnormal
- Began idea of community psychiatry
DSM
- list of all mental illnesses
- has evolved
- 400 discrete MD
- some people say it’s a cultural document
- used for diagnosis
- new diseases invented not discovered
Definitions and types are
not timeless
Theories can relate to
- Cause (distal)
- Onset (proximal)
- Course (natural history)
- Outcome (symptoms or function based)
- Recovery
- Also: labelling, stigma, inequalities, categorization
3 main theoretical lenses to view mental disorder
- Biological
- Psychological
- Social
Biological approach to MD
- primary theory used
- studies on separated twins (50% heritability of schizophrenia)
- Mixed effects of pharmacological interventions
- theories : not enough serotonin - depression, too much dopamine - schizophrenia (LACKS STRONG EVIDENCE)
- research funded by pharmaceutical companies
+ other things like sleep, exercise, diet…
Psychoanalytical approach to MD
- Childhood experience in later pathology
- interplay of unconscious through life
- struggle between personal drives and societal/familial/constraint
- “talking therapies” with trained analysts
- considered pseudoscience by mainstream psychiatry
Stress-vulnerability model
- Mental illness can be activated in people with pre-existing vulnerability
- supported by epigenetic theory
- Durkheim
- Farhis and Dunham (chicago - toxic fumes)
- Brown and Harris
Epigenetic theory
Idea that people have a genome either turned on or off based on social experience
Genes turned on might be implicated in depression
Brown and Harris
1978 - study of life events and depression
- Ongoing difficulties as important as bad life events
- Social re-adjustment rating scale
- importance of factor of transition in vulnerability
- Common theme also - certain traditional societal expectations
Labelling theory
- label used to control deviant people
- pathologizes social groups
What model is psychiatry based on today
bio-bio-bio
Individual level measurement of mental illness
diagnosis of one person
Community level measurement of mental illness
looks at statistics and samples