Models of Mental Disorders, Historical Perspectives and Classification Issues Flashcards
What do we need to do to understand mental disorders?
Need to examine the contribution of several perspectives
These perspectives are crucially involved in the definitions and approaches towards treatment and etiology
What are the different perspectives?
Cultural
- sociological / historical factors
Philosophical Foundations
- mind / body problem
Scientific Paradigms
- medical / psychological / social models
Whiteford et al (2013) - Global Burden of Disease Study
- used data from the Global Burden of Diseases, Injuries and Risk Factors Study 2010
- estimated the burden of disease attributable to mental and substance use disorders
- worldwide, mental and substance use disorders accounted for 183.9 million disability-adjusted life years OR 7.4% of total disease burden in 2010
- overall, mental and substance use disorders were the 5th leading disorder category of global disability-adjusted life years
- depressive disorders, anxiety disorders, drug use and then alcohol use disorders
Merikangas et al (2009)
- reviewed the magnitude of mental disorders in children and adolescents from recent community surveys across the world
- a lot of substantial variation in results depending upon the methodological characteristics
- BUT the findings converge in demonstrating that approximately one fourth of youth experience a mental disorder during the past year and about one third across their lifetime
- anxiety disorders - most frequent condition in children
- then behaviour, mood and then substance use
- variation in rates - methodologies & true cultural differences
- Girls - greater rates of mood and anxiety
- Boys - greater rates of behaviour
- Equal ratio for substance use
- ADHD and anxiety states begin in childhood
- Conduct disorders occur in early adolescence
- Mood disorders tend to begin in late adolescence
Historical Perspective
Past - mental disorders = a social label
- characteristics / symptoms have been known throughout history
- e.g. term ‘schizophrenia’ is relatively new
- only found its way in textbooks at the end of the 19th C
- symptoms have been described as early as 460 BC
Hippocrates (1737) - syndrome called ‘stupiditas’
- “The ill person often weeps without reason….he is frightened with reason…..he takes interest in subjects of which he is obviously ignorant….often in things which only interests scholars…..sometimes he sees images as if in dreams…”
Historical Perspective - Melancholia
One of the cardinal forms of madness in earlier times
- name and concept encapsulates the whole history of humoralism
- Melancholia - is black bile
- one of the four humor recognised in Hipporcatic and Galenic medicine
Historical Perspective - Pre and Enlightenment period
Middle ages / prior to Enlightenment
- mentally ill patients were contained to jails
E.g. Bedlam hospitals - people would pay money to visit and observe the mentally ill patients
17th and 18th C - Pinel and Esqurial
- liberated the insane from their chains
- ‘traitement morale’ - treatment thought empathy and care
Enlightenment - start of the introduction of new scientific methods and novel methods
Until recently, there were some strange and quite unscientific methods
Historical Perspective - Egas Moniz
- developed the method of the ‘lobotomy’
- neurological procedure
- consists of cutting or scraping away most of the connections to and from the PRC, the anterior part of the frontal lobes of the brain
- LATER emerged that this resulted in the loss of some important functions
- quite profound consequences - poor way of treating patients now
- at the time, this was viewed quite differently…..
Historical Perspective - 19th C
There was a big debate between proponents of the somatic approach vs psychological approach to psychiatric disorders
Historical Perspective - Somatic vs Psychological Approach
Griesinger
- “psychological disorders are brain disorders”
- mental illness are brain disorders / diseases
- remembered for initiating reforms in treatments for mentally ill P’s as well as introducing changes to the existing asylum system
- said you should integrate P’s into society and that ST hospitalisation should be combined with close cooperation of natural support systems
Historical Perspective - Somatic vs Psychological Approach
Kraeplin
- emergence of the first classification systems
- grouped diseases together based on classification of common patterns of symptoms over time, rather than just be major symptoms
Historical Perspective - Somatic vs Psychological Approach
Freud
- psychoanalysis and psychiatry
- started off as a neurophysiologist - wanted to look at the neurobiology behind it all
- said that neurology of the brain was not enough
- talked about unconscious motivations etc
Historical Perspective - Somatic vs Psychological Approach
Jaspers
- descriptive psychopathology
- was not satisfied with the popular understanding of mental illness which lead to him questioning both the diagnostic criteria and methods of clinical psychiatry
- believed that symptoms should be diagnosed more by their form rather than by their content
- e.g. hallucinations - should focus more on the form i.e. the fact that the person is experiencing visual phenomena when no sensory stimuli accounts for the it rather than what the P is actually seeing (the content)
History of Psychiatry
- over the 19th - 21st C, the direction of psychiatry has switched between organic and psychological perspectives
What are the different models of Mental Disorders?
- Sociological Approaches
- Medical Model
- Psychological Approaches
Sociological Approaches
- highlighted in the diagnoses - profound cultural factors that take display
- historical and social conventions
a) Coming and going of diagnostic categories e.g. fugue, catatonia and hysteria
- these factors suggest that not all mental disorder represent ‘natural’ entities
- disorders that experience wide shifts in terms of prevalence, e.g. eating disorders, ADHD
b) Diagnostic procedures are not always ‘objective’
- e.g. on being sane in insane places, political use of psychiatric diagnosis, homosexuality
c) Social factors have an important contribution towards incidence
- e.g. depression and schizophrenia
- powerfully constrained by social and cultural factors
d) The problem of labelling and stigma
- e.g. incidence of schizophrenia - ratings - not related / correlated
Sociological Approaches - Thomas Szasz (1960)
‘The Myth of Mental Illness’
- “mental illness, of course, it not literally a ‘thing’ - or physical object - and hence it can ‘exist’ only in the same sort of way in which other theoretical concepts exist”
For Szasz, disease = something people ‘have’ AND behaviour = what people ‘do’
- diseases are “malfunctions of the human body, of the heart, the liver, the kidney, the brain” while “no behaviour or misbehaviour is a disease or can be a disease”
- by calling certain people ‘diseased’, you are giving them a pure label
- psychiatry attempts to deny / deprive people of their responsibility as moral agents in order to better control them -> danger of SELF-FULFILLING prophecy!
Medical Model
Opposite of sociological approach?
- “when distress or inappropriate behaviour is thought to be a consequence of a bodily dysfunction, it is called a ‘disease’”
Medicine - a disease is normally diagnosed based on bodily dysfunction
Doctors - can perform lab tests, do body imaging, take medical history, do physical exams etc
Once a disease is diagnosed, the doctor generally knows the case, how the disease is likely to run its course and the appropriate treatment to take
- doesn’t really apply to mental disorders though!
