Paper 3 - Mental Health 3 - Alternative explanations of the Medical Model

Question 1

what are the behaviourist principles

Answer 1

• classical conditioning
• operant conditioning
• social learning theory

Question 2

what is the behaviourist explanation of schizophrenia

Answer 2

• 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

Question 3

what is the evidence for Scheff’s theory on behaviourism and schizophrenia

Answer 3

• 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

Question 4

what is the cognitive explanation for shizophrenia

Answer 4

• 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)

Question 5

what is the evidence for cognitive explanation of schizophrenia

Answer 5

• 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

Question 6

what is the cognitive neuroscience explanation of schizophrenia

Answer 6

• 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

Question 7

what is the evidence for cognitive neuroscience explanation of schizophrenia

Answer 7

• 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

Question 8

what is the key research in this topic about

Answer 8

szasz - the myth of mental illness

Question 9

what is the background of szasz’s research

Answer 9

• wrote a book ‘the myth of mental illness’ in 1960
• challenging the medical model and psychiatry on the physical causes and treatment

Question 10

what is the aims of szasz research

Answer 10

• 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

Question 11

how does szesz explain that mental illness is a metaphor

Answer 11

• 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

Question 12

what was under the section 50years of change in USA mental healthcare

Answer 12

• 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

Question 13

what was under the section mental illness - a medical or legal concept

Answer 13

• 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

Question 14

what is in the section changing perspectives on human life and illness

Answer 14

• 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

Question 15

what is in the section mental illness is in the eye of the beholder

Answer 15

• 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

Question 16

what is under the section revisiting the myth of mental illness

Answer 16

• 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

Question 17

what is under the secion having illness does not male an indiviudal into a patient

Answer 17

• 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