Paper 3 - Mental health 1 - historical context Flashcards
1
Q
what are the prehistorical supernatural explanations of mental illness
A
- abnormal behaviour attributed to demonic possession, witchcraft or a punishment by god for wrongdoings
- reductionism
2
Q
what are prehistorical supernatural treatments for mental illness
A
- involve prayers, holy water, exorcisms to release evil spirits including trephining, stretching, whipping, immersing or boiling water or freezing water
- this is to make the demonic spirit leave
- doing good deeds and having positive thoughts to impress god
3
Q
what is the greek culture of mental health explanation
A
- hippocrates argued that mental ilness was not caused by supernatural possession but physiology
- a healthy personailty was created by a balance of 4 humours - black bile,yellow bile, blood and phlegm.
- mental disorders were caused by an imbalance or exess of a humour.
- black bile linked to being quiet and restless
- blood linked to being hopeful and playful
- phlegm linked to calm and pateint
- yellow bile linked to mania
- biologically reductionist
4
Q
what were the greek cultures treatments of mental ilness
A
- correct the imabalnce of the humours by purging or laxitives or blood letting using leeches
- also changes to lifestyle, diet and exercise
- patients were looked after and not stigmatised
5
Q
what is the phsycogenic approach of mental illness cause
A
- attributed to pyschological factors
- freud attributed to conflicts within the unconscious mind and childhood experiences (holistic)
6
Q
what is the psychogenic appraoch of treatments
A
- psychoanalysis to gain insights into unconscious mind, hidden and past thoughts
- including dream analysis and free association
- becomes a dominant treatment in the 1900s
- this led to many more talking therapies like councelling
7
Q
what is the somatogenic approach to cause of mental illness
A
- renewed focus on physical causes
- the medical model which saw mental ilness as caused by genetics, abnormal brain structure and neurotransmitters
- scientific, biological causes, empirical evidence, objective judgements
8
Q
what are the treatments for somatogenic approach
A
- biological treatments including electroconvulsive therapy (electric currents into the brain), psychosurgery (parts of the brain are removed) and psychopharmacology (drugs)
- drug therapy are now the dominant treatments to correct abnormally high or low neurotransmitters.
- this made care in the community possible - patients could live at home or in a communal facility whilst keeping their disorder controled
9
Q
what are similarities between the greek theory and the somotagenic theory
A
- they both have physical/biological causes
- greek = imbalance of 4 biological humours
- somotagenic = imbalance of biological neurotransmitters
10
Q
what are similarities between prehistorical and psychogenic theories
A
- bothmake subjective judgements based on their own personal beliefs, e.g. religion and morals
- prehistorical = punishments from wrong doings
- psychogenic = unresolved unconscious conflicts
11
Q
what are differences between the somotagenic and psychogenic
A
- somotagenic = bioloically reductionist, 4 humours imbalance
- psychogenic = holist, unresolved unconscious conflicts and childhood experiences
12
Q
what are similarities/ differences of treatments
A
- all 4 of them offer treatments
- however all treatments are different e.g. psychogenic is not physical treatment but prehistorical is
13
Q
what are the 4 definitions of abnormality
A
- statistical infrequency
- deviation from social norms
- failure to function adequately
- deviation from ideal mental health
14
Q
what is the definition and evaluation of statistical infrequency for abnormality
A
- deviation from statistical norm
- relatively frequent behaviour or chatacteristic can be thought as normal
- anything that is diferent to this is abnormal
- evaluation strengths - objective, quantitative and scientific measurements, e.g. Hancock’s study
- evaluation weaknesses - rare but desirable behaviours are labelled as abnormal, e.g. high IQ.
- some mental illnesses are statistically common but doesnt mean that its not a problem, e.g. anxiety
- some rare behaviours are not related to normality or abnormality, e.g. being left handed.
15
Q
what is the definition and evaluation of deviation from social norms
A
- not participating in expected standard behaviours, e.g. queueing
- determined by societys views on how we should act
- making a collective judgement as a society on what is right.
- evaluation strengths - could lead to treatment if others notice it
- evaluation weaknesses - behaving in a different way is not abnormal if a person is functioning well
- cultural relativism - breaking the norm of being an unmarried mother could have the woman put in an assylum 100 years ago but would not now - culture changes over time.
16
Q
what is the definition and evaluation of failure to function adequately
A
- no longer cope with the demands of everyday life
- rosenhan and seligman created a list, the more things on the list the more likely thay are to be abnormal
- personal distress, unpredictability, observer distress, irrational behaviour, maladaptive,e.g. cant sustain relationships
- evaluation strengths - practical checklist
- matches sufferes perceptions, e.g. may feel distress
- can lead to person or friends and family seeking help
- evaluation weakness - may not link to abnormality,e.g. keeeping jobs during recession
- cultural relativism - in some culutres people feel distress when watching same sex relationships but some dont
- context dependency - going on a hunger strike may be seen as irrational but not if the person has been wrongly imprisoned
17
Q
what is the definition and evaluation of deviation from ideal mental health
A
- jahoda’s criterea for good mental health, those lacking items on the list are abnormal
- resistannce to stress, self actualisation, high self esteem, autonomy (independence), accurate perception of reality, empahty
- evaluation strengths - gives patients something to aim for
- evaluation weaknesses - difficult to achieve
- cultural relativism - individualists independence is more impotant than community in collectivist cultures
18
Q
what is the similarities and differences of all the definitions of abnormal behaviour
A
- all apart from statistical infrequency use subjective value judgements
- only statistical infrequency deals with objective quantitative data
- failture to function and ideal mental health have checklists
- ideal mental health is the only positive definition - provides goals for people
- all except statistical infrequency are context dependent/ culturally relative.
19
Q
what are the 2 classifications and diagnosis of mental disorders
A
- DSM-V
- ICD 10
20
Q
What is DSM-V
A
- Diagnosis statistical manual of mental disorders (used in USA)
- Only lists mental disorders
- has 20 categories of disorders listen in lifespan order
- has a section on disorders needing certain research
- has a section on understanding cultural contexts to prevent cultural bias in diagnosis,e.g. hearing voices may be seen as a gift in some cultures
- published by the american psychiatry association (concern over pressure from pharmaceutical companies)
21
Q
what is ICD 10
A
- International classification of disorders version 10 (used in UK and europe)
- lists physical and mental disorders
- has 21 chapters with categories and sub categoriesm e.g. schizophrenia is listed under schizotypical and delussional disorders and includes different types of schizofrenia, e.g. paranoid, catatonic
- Chapter 5 has psychological disorders of psychological development and mental and behavioural disorders due to psychoactive substance use (drug use)
- published by the WORLD HEALTH ORGANISATION they are concerned with diagnosing disorders and looking for patterns in disease.
22
Q
what is the background of Rosenhan’s research on being sane in insane places
A
- research has shown than the reliability of classification systems were very poor.
23
Q
what is the method of Rosenhans study
A
- field experiment
- participant observation
- self report
24
Q
what is the sample of rosenhans research
A
- the pseudo patients were 8 sane people
- 5 men, 3 women
- used fake names and fake ocupations
25
Q
what is the aim of procedure 1
A
to see whether a group of people presenting themsleves as having a disorder would be diagnosed as inane by staff at psychiatric hospitals
26
Q
what is the procedure part 1 of rosenhan’s research
A
- sane patients called the hospitals across 5 states in the USA and arranged an appointment
- on arrival they reported that they’d been hearing voices which were unclear, unfamiliar, of the same sex as themselves and said ‘epmty’ ‘hollow’ and ‘thud’
- which are not syptoms of schizophrenia
- they were all admitted and participated in ward activities
- they didnt swallow medication given to them
- when asked by staff how they were feeling they indicated that they were fine and no longer had symptoms.
- on admission they observed behaviour of staff and genuine patients and recorded it in a notebook
- sane patients had the responsibility of persuading hospital staff that they were sane and should be discharged.
27
Q
what are the results of part 1 of rosenhans study
A
- all the sane patients were admitted to hospitals and had a mean stay of 19 days
- 7/8 were diagnosed as schizophrenic, the other for manic depressive psychosis
- all left with diagnosises of schizophrenia in remission
- none of the staff asked them what there note taking was ‘patient engages in writing behaviour’
- if a patient became upset by staff the response was seen as a result of their illness not the situation
- many real patients detected the fake patients 35/118 genuine patients voices their suspicion’you’re not crazy’ ‘you’re a journalist’
- all fake patients experienced powerlessness and depersonalisation
28
Q
what is the aim of procedure 2
A
- to see if psychiatrists and mental healthy workers would be undercautious or overcautious because they had been told about the mistaken diagnosis.
29
Q
what is part 2 of the procedure of rosenhans study
A
- hospitals were informed about their diagnosis errors
- they found this difficult to believe
- they were warned that one more sane patient present themsleves over the next 3 months (no one did)
- each member of staff was asked to rate each pateint who arrived at admission according to the likelyhood that they were a fake patient using a 10 point scale (questionnaire)
30
Q
what is the results for part 2 of the procedure
A
- although no fake patient appears
- 41/193 patients were judged with high confidence of being fake by atleast one member of staff
31
Q
what are the conclusions of rosenhans study
A
- diagnosis is extremely inaccurate r
- osenhans claim that we cannot distinguish the sane from the insane is given support
- hospitals seem to be special environments where behaviour gets easily distorted and pateints are treated in a way to encourage their problems rather than supporting them
- patents experience powerlessness and depersonalisation
- once a patient has been labelled insane all subsequent behaviour is seen as insane
- institutionalisation in psychiatric hospitals has negative effect on internal pateints
- mental health workers are insensitive to feelings of patients
- DSM - Version 3 has poor reliability
- diagnosis can be influenced by situation an individual finds themself in
- ‘stickiiness of psychiatric labels’ - once a label is given all their characteristics are seen as abnormal
32
Q
what are the aims, procedures and results of the mini experiment by rosenhan
A
- aim - to see if staff behave differently to patients compared to non patients
- procedure - ‘ could you tell me when i will be presened in the staf meeting’ by a patient in hospital or ‘do you know where… is’ by a non patient on a uni campus
- results - 4% of patients got an answer from psychiatrists
- all 14 requests were acknowledged and repsonded to on the campus.
33
Q
what are the 3 main types of mental illnesses
A
- affective disorders - depression
- psychotic disorders - schizophrenia
- anxiety disorders - phobias
34
Q
what is depression
A
- mood disorder
- involves persistent feelings of sadness and loss of interest.
- It can affect how you think, feel, and behave.
- significant effect on an indivual’s emotional state
35
Q
what are the key symptoms of depression
A
- diagnosis requires 2 key symtptoms and 2 other symptomsover 2 weeks.
- low mood nearly every day
- loss of interest and pleasure in everyday activities
- reduced energy levels, causing people to withdraw from work, education and social life
other symptoms - changes in sleeping pattern
- changes in apetite levels
- decrease in self confidence
36
Q
what is the data for depression
A
- most common mental health disorder
- one in five people are likely to experience depression at some point in their life
- affects all age groups but tends to be more common in younger people
- twice as many females are diagnosed with depression than men
- found in all cultures 120million people world wide have depression
- can be in response to a life event or from inside the individual, e.g. low levels of dopamine
37
Q
what is schizophrenia
A
- pateint has lost touch with reality
and has abnormal perception and thinking
38
Q
explain the data of schizophrenia
A
- 1% of the global population
- tends to develop in early adulthood
- 25% of patients have one episode and then revover, a similar amount never recover and 50% improve but may experiece similar epsiodes during lifetime
- ICD-10 recognises a range of subbtypes
- paranoid schizophrenia -characterised by powerful delusions and hallucinations
- hebephrenic schizophrenia - negative symptoms
- DSM-V for a diagnosis - two or more symptom should be present over 1 month
39
Q
what are the positive symptoms of schizophrenia
A
- behaviours are added
- hallucinations - unusual sensory experience like hearing voices or seeing something
- delusions - irrational beliefs like thinking you are someone famous or beliving you are being persecuted
40
Q
what are negative symtoms of schizophrenia
A
- lacks normal behaviour
- (avolition) reduced motivation to carry out a range of activities
- (agolia) reduced amount and quality of speech
41
Q
what are the cognitive deficits of schizophrenia
A
- mental processes are affected
- disorganised thought or speech such as jumping between thoughts
- thought insersion like believing your thoughts are being placed by someone else
42
Q
what is a phobia
A
- characterised by a strong, persisent and irrational fear of an object, situation or activity
- the fear is out of proportion to the risk the object presents
- primary symptom of extreme anxiety
- individuals take extreme measures to avoid contact
- clinical phobia when it interferes with normal life
- divided into agoraphobia (fear of open space/being unable to escape), social phobia (fear of social situation) and specific phobia (isolated)
43
Q
explain the data for specific phobias
A
- most common anxiety disorder
- 3% of females and 2% of males in the UK will have a phobia
- most common one is arachnophobia
44
Q
what are the ICD-10 symptoms for specific phobias
A
- symtpoms of anxiety in the feared situation with at least 2 symptoms present together from a list of 14 symptoms including pounding heart, sweating, trembling, dry mouth, nausea, fear of dying
- plus: significant emotional distress due to avoidance of the anxiety symptoms and a recognition that these are excessive or unreasonable.
45
Q
evaluate the validity in this topic
A
- external/ecological validity - real hospital with real staff and patients so is representitive of true behaviour
- internal reliability - standardised procedures between each hospita
- low population validity - rosenhan used USA hospitals only one culture
- statistical infrequencies - objective quantitative data
- greek 4 humors - observable and measurable
- somatogenic - measurable (fMRI scans)
- social norms and mental health - too subjective
- low validity - DSM is ethnocentric, based on resarch on mid class white people resulting in culture bias in diagnosis.
- but DSM-V has guidance to prevent cultural bias
- low validity - some disorders occur together making it difficult to diagnose and offer the correct treatment to the primary (first)disorder.
- Also some symptons appear in more than one disorder - anxiety is a syptom of schizophrenia, depression, OCD and phobias which can result in incorrect diagnosis and treatment.
46
Q
evaluate sampling bias in this topic
A
- low population validity - only USA hospitals
- high internal validity - standardised procedures
- ethnocentric DSM research is based on white middle class
- But DSMV has culture bound syndromes and guides
- cultural relavitism of definitions of abnormality
47
Q
evaluate the reliability of this topic
A
- standardised procedures allowed for it to be replicated across hospitals
- Brown found the reliability of diagnosis usin DSM was 0.67 (high positive correlation) showing good agreement between clinicians when diagnosing the same person for depression
- rosenhan only sent one observer to each hospital. Not all observers may have acted the same way.
- Brown found the reliability of diagnosis using DSM was 0.67 (high positive corellation) showing good agreement betwween different clinicians when diagnosing the same person for depression 2 weeks apart using 362 pps.
- copeland gave 134 US and 194 british psychiatrists a description of a patient. 69% of the us psychiatrists diagnosed schizofrenia but only 2% of british ones gave the same diagnosis. shows the problems of using different classification systems
48
Q
evaluate ethnocentrism in this topic
A
- Rosenhans study only done in american hospitals
- Failure to function adequately - observer distress is culturally relative, e.g. drinking alcohol, showing affection (age)
- Deviation from ideal mental health - autonomy in individualist vs collectivist
- deviation from social norms - queueing vs jumping queues is culturally relative
- Statistical infrequencies - not ethnocentric, based on objective quantitative data.
49
Q
evaluate freewill/determinism in this topic
A
- rosenhan - environment of being in the hospital with staff labelling you determines how staff respond to any behaviour
- biological determinism - greek 4 humours
- freewill - failure to function inadequately suggests that people have the free will to reverse the problem on the list ,e.g. social skills training. people are exercising freewill.
50
Q
evaluate nature/nurture in this topic
A
- nature - greek 4 humors, somatogenic
- nurture - deviation from social norms is context dependent
- interactionist - an individual cant work but social skills training may help - an interactionist between the individual and their situation.
- nurture - rosenhan’s labelling
51
Q
evaluate socially sensitive of this topic
A
- socially sensitive - many nurses complained that it made their profession look bad
- socially sensitive - people may not trust diagnosis or psychiatric hospitals
- however DSM was updates and made more strict
- deviation from social norms - people get labelled and treated differently, placed in psyhiatric hospitals
- freud - psychosexual development comes from childhood interactions. socially sensitive to parents (guily)
52
Q
evaluate reductionism/holism in this topic
A
- biological reductionism - greek 4 humors, somatogenic
- environmentally reductionist - rosenhans labelling, deviation from social norms is context dependent
- holism - an individual cant work but social skills training may help - an interactionist between the individual and their situation.
53
Q
evaluate the usefulness of this topic
A
- rosenhan showed the dificulties of definint abnormality and showed how stigma arises and the negative effect of labelling - stickiness of labels
- useful in making DSM more strict, e.g. from 1 week of symptoms to 1 month
- suppored anti-psychiatry movement - medicalisation of behaviour, illustrates differences between diagnosis of physical and mental disorders.
- not useful - any methodological issues
54
Q
evaluate ethics in this topic
A
- no right to withdraw
- no informed consent
- hospital staff were decieved into thinking they were real patients. they also thought they would be sent fake patients but they werent
- harm - nurses were angry and embarrased that their profession was made to look bad
- cost benefit analysis tells us that the ethical breaches were worth it because DSM was updated and people arent getting wrongly diagnoses, e.g. 1 week vs 1 month for schizophrenia
