Philosophy of psychopathology Flashcards
Is grief a disroder?
DSM 5
“feelings of deep sadness, loss, sleeplessness, crying, inability to concentrate, tiredness, and no appetite, which continue for more than 2 weeks after the death of a loved one, could be diagnosed as depression, rather than as a normal grief reaction”
• DSM 5 will dramatically increase the rates of mental disorder:
1) by reducing thresholds for existing disorders; and,
2) by introducing new high prevalence disorders at the boundary with normality.
outline why the 60’s was an important time for psychopatholgoy
Drugs- recreational and pharmaceutical
Vietnam war- lots of protests
Homosexuality- mental disroder/not?
Important movements e.g. postmodernisation
Student movements- may68
Antipsychiatry
Behaviourism and psychoanalysis
give the hisroty of madness in the classic age
Middle Ages: social and physical exclusion of lepers Gradual disappearance of leprosyà madness came to occupy this excluded position.
§Ship of fools (15th) à exclusionary practice: sending mad people away in ships.
§Renaissance: humans can not come close to the Reason of God / Madmen are those who had come too close to God’s Reason, accepted in society.
§ 17th : the Great Confinement à “unreasonable” members systematically locked away and institutionalized. §18th : Madness (vs Reason) àhaving lost what made them human (i.e reason) , they became animal-like and therefore treated as such.
§19th : madness was regarded as a “curable” mental illness ( e.g. Pinel, Freud).
outline Foucault’s argument
Trying to understand where defination of mental disorder came from and conceptualsied?
1.Early Middle Ages: Parallel between the medieval isolation of lepers and the modern isolation of madness àBoth lepers and the mad were objects of fearand repulsion; isolated in houses designed more for separation from society than for cures; used as joint signs of divine justice and mercy; and in some cases funds and institutions originally meant for lepers came to be used for the mad.
- Late Middle Ages and early Renaissance the mad led an ‘easy wandering life,’ madness having been recognized as part of truth.
- Mid 17th Century: The Age of the Great Confinementà exclusion and confinement were distinctive features of the Classical Age’s attitude toward madness.
- 19th century posits a transition to madness as mental illness à Tuke and Pinel “invented” mental illness
what was in the classical experience of madness?
-not interested in the event of confinement as such -interested in the attitudes toward and perceptions of madness connected with it
Madness as one division of a wider category : “unreason”
Not only the mad, but also a wide variety of other people were confined à “les libertins”: §Mad §sexual offenders §those guilty of religious profanation, §free-thinkers
outline the different levels identified in the classical experience of madness
1st level: Confinement as an economic policy meant to deal with problems of poverty (e.g. begging and unemployment)
• Getting a large class of idle, potentially disruptive people off the streets and putting them to work in a controlled environment
• Success ? a failure àit hid but did not eliminate poverty
“the Classical experience of madness.”
2nd level:(Calvin) religious basis for the ethical centrality of work: • Those confined were not regarded as the neutral objects of unfortunate economic processes, but as moral troublemakers worthy of society’s condemnation and punishment.
• Implicit in the Classical condemnation of “unreasoning” behavior was a deep restructuring of moral categories à mad =animal
• “madness is assimilated to the broader category of unreason” • It is detentionrather than treatmentof the mad that is characteristically Classical
outline what we know from “from morals to science”
18th-19th : “humanization” of treatment in the work of Pinel freeing the chained at the Salpêtriére, Tuke in England
- Madness is a disease of “mind,” not possession by evil demons.
- Madness remains something “other,” something “not I.”
- 96,000 souls came to watch the inmates at Bedlam Hospital in London
From the mid-19th century through the present we see a shift in the treatment of madness to the “asylum” :
• By medicalizing madness, we presumably move from moral derision to scientific categories of etiology, nosology, and treatment plans.
what was R.D Laing all about?
Anti psychiatry
RD Laing (1927-1989) psychiatry was founded on a false epistemology: illness diagnosed by conduct but treated biologically. • challenge the core values of a psychiatry which considers mental illness as primarily a biological phenomenon, of no social, intellectual or political significance.
antipsychiatry first used by the South African psychiatrist David Cooper in 1967
what are the two central contentions of antipsychiatry
- The specific definitions of, or criteria for, current psychiatric diagnoses or disorders are vague and arbitrary, leaving too much room for opinions and interpretations to meet basic scientific standards.
- Prevailing psychiatric treatments are ultimately far more damaging than helpful to patients.
give critisisms of psychriatric authority
- inappropriate and overuse of medical concepts and tools to understand the mind and society;
- scientifically and/or clinically ill-founded system of categorical diagnoses (e.g., DSM) & stigmatization
- unexamined abuse or misuse of power over patients who are too often treated against their will;
- compromise of medical and ethical integrity because of psychiatrists’ financial and professional links with pharmaceutical companies and insurance companies.
outline David Rosenhans experiment
David Rosenhan experiement
8 sane ppts
Told “say you can hear a voice saying “thud”” otherwise act normally”
All told they were insane and kept inside despite acting normally All put on powerful psychotrophic drugs Only way ot get out was to say insane and fake "getting better"
Second experiemtn:
Sent nonone but told they did to hospital
Told they had identified 41 fakes even though no fakes
Type II error : find “illness in health
outline Wakefields theory
Wakefield: “The concept of mental disorder” 1. Sexual, racial and sexual orientational biases in diagnosis
2. Psychodiagnosis is often used to controlor stigmatizesocially undesirable behavior that is not really disordered
See “drapetomania”, “childhood masturbation disorder”, “premenstrual syndrome”, “alcoholism”, “hyperactivity”, “homosexuality”
what is drapetomania?
Drapetomania (1851):
a sickness of the mind that makes you want to run away.
affects only black people
does not seem to affect whites
especially common in the American South in the early 1800s.
what is homosexuality as a mental health disorder?
1973: American Psychiatric Association removes homosexuality from DSM
1986: Diagnosis was removed entirely from DSM. The only hint of ego-dystonic homosexuality in the revised DSM-III occurred under Sexual Disorders
Not Otherwise Specified, which included persistent and marked distress about one’s sexual orientation (American Psychiatric Association, 1987; see Bayer, 1987, for an account of the events leading up to the 1973 and 1986 decisions).
When did it stop being a “mental” disorder?
WHY? the weight of empirical data, coupled with changing social norms and the development of a politically active gay community in USA
Psychologists (APA) removed it in 1975
Replaced by a new diagnosis, ego-dystonic homosexuality (DSM II) characterized by:
(1) a persistent lack of heterosexual arousal, which the patient experienced as interfering with initiation or maintenance of wanted heterosexual relationships, and
(2) persistent distress from a sustained pattern of unwanted homosexual arousal.
Why is it important to understand the concept?
For constructing “conceptually valid” diagnostic criteria that are good discriminators between disorder and non-disorder
