Paper 3 - Mental Health 3 - Alternative explanations of the Medical Model Flashcards
1
Q
what are the behaviourist principles
A
- classical conditioning
- operant conditioning
- social learning theory
2
Q
what is the behaviourist explanation of schizophrenia
A
- schizophrenia is the results of faulty learning - operant conditioning
- a lack of positive reinforcement and too much punishment makes the child focus on irrelevant environmental cues - things that will get them attention.
- e.g. focusing on the movement of the mouth when saying words rather than the word itself
- this strange behaviour gets attention - positively reinforced and is repeated along with further strange behaviours
- these are labelled schizophrenic = schizophrenia diagnosis
- punishment leads to withdrawl and more odd behaviours for more attention, other people avoid the child so the strange behaviours increase into a psychotic state (Liberman’s theory)
- this is referred to as Schieff’s labelling theory: The primary deviance is the person’s strange behaviour and the secondary deviance is other people’s reactions which worsen the situation
3
Q
what is the evidence for Scheff’s theory on behaviourism and schizophrenia
A
- he used Rosenhan’s study as support
- the pseudo patients reporting hearing the words ‘thud’ ‘hollow’ or ‘empty’
- led to a labelling of schizophrenia
- which lead to nurses and doctors ignoring the patients in study 3
- which is a lack of positive reinforcement/ attention
4
Q
what is the cognitive explanation for shizophrenia
A
- internal mental processes - how we think and percieve others and outselves causes mental disorders
- disordered thinking - Frith - schizophrenics are consciously aware of cognitive processes, e.g. thoughts, perceptions that most people are not
- therefore there is a sesnory overload as so much info is being processed consciously leading to attention deficit theory (Frith’s name for this)
5
Q
what is the evidence for cognitive explanation of schizophrenia
A
- Somaia Mohammed et al compared 94 diagnosed schizophrenic pps recently admitted to a psychiatric warn in USA to 305 clinally normal people
- The pps had deficits in recall, sequencing, organisation, attention, language comprehension, social cognition and stroop performance = cognitive deficits within the symptoms of schizophrenia
6
Q
what is the cognitive neuroscience explanation of schizophrenia
A
- combines a measurement of brain activity with simultaneous performance of cognitive tasks
- Frith - the Septo hippocampal brain circuit (amygdala and hippocampus) stops being regulated by the prefrontal cortex.
- results in patients not being able to tell the difference between internal intentions and external stimuli so the cognitive effect is hearing yout oen inner voice as another persons = hallucination
- Agolia (speech poverty) and incoherent speech stem fro structural and functional abnormalities in the primary auditory cortex in the temperol lobe and the prefrontal cortex which both process meaning of language
7
Q
what is the evidence for cognitive neuroscience explanation of schizophrenia
A
- kuperberg - fMRI scans of 17 chronic schizophrenic patients
- showed increases activity of temperol and inferior prefrontal cortex when looking at semantically related words compared to controls
- the hyperactivity shows those areas are not functioning properly
- aleman - increased perfrontal activity when doing working memory tasks.
- if tasks became too hard brain activity decreased compared to controls
- this shows a neural bias for cognitive deficts
8
Q
what is the key research in this topic about
A
szasz - the myth of mental illness
9
Q
what is the background of szasz’s research
A
- wrote a book ‘the myth of mental illness’ in 1960
- challenging the medical model and psychiatry on the physical causes and treatment
10
Q
what is the aims of szasz research
A
- challenge the medical model and psychiatry on the concept of mental illness
- reject psychiatric treatments
- stop saying mental illness - its disorienting individual behaviour
- reject image of patients as helpless victims
- stop coerscive psychiatric practices
11
Q
how does szesz explain that mental illness is a metaphor
A
- mental illness is a symbol of something else
- e.g. Beriberi causes mental confusion but it is a vitamin b1 deficiency = a physical not mental cause
12
Q
what was under the section 50years of change in USA mental healthcare
A
- in the 1950s no one felt that it was the governments responsibility to provide health care.
- most people were considered incurable and were kept in mental hospitals
- some patients voluntarily got help and others who could afford it got private treatment
- now, it is the responsibility of the government
- the focus is on a legal requirement to prevent patients being a danger to others and themselves
- there is no legally valid non-medical approach to mental illness
13
Q
what was under the section mental illness - a medical or legal concept
A
- mental illnesses are defined by political and economic criterea. Eg homosexuality was removed from DSM and ICD
- this shows mental illness is not a real phenomenon if it can be changes so easily
- those in power determine that mental illness is like a physical illness. Bill Clinton US president said ‘mental illlness can be accurately diagnosed successfully treated just as a physical illness’
- the idea tat mental illness has a physical cause is not based on scientific research.
- ‘mental illness’ is just a phrase which supposedly represents a real pysical change but with no evidence.
- mental hospitals are likke prisons, patients are there involuntarily and are treated like prisoners rather than getting treatment for illness
- the psychiatrists are judges not healers. psychiatry should be discarded in consideration of morals and laws
14
Q
what is in the section changing perspectives on human life and illness
A
- the view that mental illness is a myth is not new, it has been questioned for many centuries
- however now, people have replaced religious explanations with pseudomedical ones
- instead of praying to god for help we go to a medical doctor
15
Q
what is in the section mental illness is in the eye of the beholder
A
- behaviours we call mental illness are not medical illnesses
- when a person displays abnormal behaviour we medicalise it and look for a treatment
- medical treatment of physical illnesses require patient consent
- but not with mental illness which is a validation of human rights
- a physically ill patients feelings are important and they can accept or reject medical diagnosis and treatment but a mentally ill pps is seen as a danger to themselves and the public and psychiatrist must protect both.
- the ethical principle in medicine is ‘do not harm’ mentally ill patients are judged and treated differently
16
Q
what is under the section revisiting the myth of mental illness
A
- critis continue to understand that the myhth of mental illness was a radical effort to recast mental illness from a medical problem to a rhetorical phenominom
- vatz and weinberg agree with szatzs medical model langugae is used to justify controlling people
17
Q
what is under the secion having illness does not male an indiviudal into a patient
A
- treatment is seen as necessary
- this leads to 2 radically different ways of treating mental illness
- curing or healing by using conversations,e.g. cbt
- controlling or coercing patients forecefully which has been authorised by the state
- in the past, people accepted religious justification of coercive treatments, today people accept medical justifications
- Eugen Bleuler argued that people with schizophrenia should be able to define and control their own lives, psychiatry should not stop them taking their oen lives. but the opposite happened
18
Q
what is the application for this topic
A
CBT - Cognitive behavioural therapy
19
Q
what happens in CBT
A
- aims to identify irrational thoughts and change them
- takes place between 5 and 20 sessions
- can be individual or in groups
- wont get rid of symptoms but will make them cope better
- may involve an arguement or discussion of how likley the beliefs are to be true, and a consideration of less threatening possibilities
20
Q
how does CBT help
A
- helps make sense of how their delusions and hallucinations impact their feelings or behaviour
- understanding where symptoms come from can provide relief
- e.g. hearing voices may make someone afraid
- offering psychological explanations reduces this anxiety
- delusions can also be challenged so they learn beliefs are not based on reality
21
Q
what is the assessment stage of CBT
A
- the therapist encourages the patient to explain their concerns
- describing delusions
- reflecting on relationships
- laying out what they hope to acheieve
22
Q
what is the engagement stage of CBT
A
- therapist wins the trust so they can work together
- honesty patience and unconditional acceptance
23
Q
what is the normalisation stage in CBT
A
- help the pateint realise it is normal to have negative thoughts in certain situations
- so no need to feel stressed or ashamed
24
Q
what is the critical collaborative analysis of CBT
A
- a logical discussion till the pps begins to see where their ideas are wrong and why they developed
- work out ways to recognise negative thougths and test beliefs when they arise and rethink them
25
what is developing alternative explanation stage of CBT
* finding logical reasons of things which trouble them
* let them develop their own theories
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what are the strengths of CBT
* Does reduce releapse in hosptial (NICE 2014)
* Turkington -CBT is highly effective and should be used as mainatream treatment
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what are weaknesses of CBT
* requires self awareness and willingness to engage - symptoms opose self awareness
* lengthly - takes months compared to drugs - pps may be disenaged
* Addington - CBT is of little use in early stages of active schizophrenic episode
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what is the economic evaluation of CBT
* an expensive treatment as it requires special training and qualifications
* each therapy session can be costly - impact on health care system
* however this might be outweighed by the economic gain when patients become a member of society
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what is the central idea of CBT
* Patients problems are based on incorrect beliefs and expectations
30
what is the nature/nurture debate in this topic
* nature - cognitive neuroscience - kuperberg found hyperactivity in the temporal and prefrontal cortex for schizophrenics shown semantically similar words
* nature - cognitive - frith - found an attention deficit - too much information is processed by the mind as internal thoughts are no longer filtered before reaching the conscious mind leading to the sensory overload. Somaia Mohamed found 94 schizophrenia patients had problems with memory attention, organisation, language supporting attention deficit theory
* nurture - behaviourist thoery if schizophrenia - reinforcement of odd behaviours leads to developing a phsycotic state
31
evaluate freewill/determinism in this topic
* bio determinism - cognitive neuroscience - kuperberg found hyperactivity in the temporal and prefrontal cortex for schizophrenics shown semantically similar words
* freewill - cognitive -use of CBT shows freewill
* environmental determinism - behaviourist thoery if schizophrenia - reinforcement of odd behaviours leads to developing a phsycotic state
32
evaluate reductionism/ holism
* biological reductionism - cognitive neuroscience - kuperberg found hyperactivity in the temporal and prefrontal cortex for schizophrenics shown semantically similar words
* holism - szasz is holist - individuals should be diagnosed by considering the whole person who has thoughts and feelings rather than using a list syptoms. disturbed behaviours are psychological syotoms and should be explained and treated psychologically, e.g. cbt not medicine
* environmental reductionism - behaviourist thoery if schizophrenia - reinforcement of odd behaviours leads to developing a phsycotic state
*
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evaluate ethics in this topic
* informed consent - cognitive neuroscience explains cognitive deficits, e.g. disorganised speech/ thoughts. pps lack insight and may be unable to consent to research e.g. kuperberg did fMRI scans - found hyperactivity in temperol and prefrontal cortex when presented with sematically similar words.
* harm - cognitive model - somaia mohammed found cognitive deficits in 94 pps newly admitted to hospital- memory attention, language, organisation and stroop. may be first time they realised this causing stress
* less harm - szasz rejects the medical model and wants more humane treatments with consent and no side effects, e.g. CBT leads to reduces relapse
34
evaluate usefulness in this topic
* szasz - exposing politicisation and medicalisation of psychiatry - putting limits on psychiatrists power e.g. rosenhan experiment 3
* szasz - says mental illness if a myth stops people from seeking help. Leucht showed antipsychotic reduced relapse by 27%
* difficult to assess szasz for validity - theyre subjective opinions not objective empirical evidence unlike seeman D2 receptors
* behavioural model - theoretical - can explain schizophrenia but only evidence looks at patients treatment after diagnosis, not supporting the model as a cause
35
evaluate socially sensitive research in this topic
* strength - szasz view offers an interesting alternative view of mental illness as a myth over medicalisation. ss as it could stop those needing help from getting it causing suffering when medications are effective, e.g. leucht
* weakness - negative labelling - the anti psychiatrist movement promoted rosenhans study which exposed poor diagnosis and treatment. ss as it embarrassed staff
* strength - szasz may have promoted more humane treatments like CBT
36
evaluate validity in this study
* difficult to assess validity of szasz essay based on opinion not empircal evidence
* internal validity - cognitive neuroscience has empirical research - Kuperberg found increased activity in temporal and prefrontal cortex using fMRI
* behvaioural model lacks validity - rosenhans supporting evidence shos lack of positive reinforcement and negative punishment which may cause symptoms to continue but does not support operant conditioning initiated scizophrenia
37
evaluate reliability in thos topic
* fMRI scans have low test retest reliability
* somaia mohammed studied cognitve deficits which has good inter rater reliability researchers all agreed on the range of deficits
* alternative theory of CBT is reliable - Hofmann - reviewed 106 meta analysis for schizophrenia and other disorders. response rates were higher than for other treatments - this supports szasz that more humane non medical treatments should be used
38
evaluate sampling bias in this topic
* somaia mohammed = large representitive sample compared cognitive deficits in 94 schizophrenic patients and 305 normal controls. but the study is done in USA which diagnoses using DSM - cannot generalise to europe which uses ICD which recognises subtypes
* behaviouris explanation is based on research with animals - skinners rats and pigeons - reinforcements and punishments can explain simple response behaviour but it is difficult to generalise to hallucinations and delusions. rosenhans tsudy 3 looked and reinfoecement and punihsment for asking questions is only based on 8 pps
* szasz - myth of mental illness - opinion of only one man. althought he could be sen as the spokesman for the anti psychiatry movement which included rosenhans colleagues. did result in DSM being updated
39
evaluate ethnocentrism in this study
* is - the medical model assumed the causes of mental illnss are universal due to causes being biological. however alternative explanations are culturally specific, e.g. szasz says mental illness in usa in politicised meaning that how it is viewed is affectived by dominant groups in society.this guides the gov spending on mental health e.g. more spent on medication then cbt
* somaia mohammed = large representitive sample compared cognitive deficits in 94 schizophrenic patients and 305 normal controls. but the study is done in USA which diagnoses using DSM - cannot generalise to europe which uses ICD which recognises subtypes
* is not - cognitive neuroscience has a biological basis e.g. frith states that the breakdown in the septo hippocampal system explains the delusions in schizophrenia. however delusions will be impacte by local culture.
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