Psychiatric Disorders

Question 1

Mental illness

Answer 1

• Biological basis, but also
• Socially defined
• Evolving
• Boundaries somewhat arbitrary (ie. Schizoaffective disorder – symptoms of schizophrenia, depression, etc.)
• A constellation of symptoms (should treat the symptoms, not the disease, since people with the same diagnosis might have slightly different symptoms)
• • Polytreatment (ie. If you have bipolar disorder, you might have one treatment for mania, one for depression, etc.)

Question 2

3 things that were previously considered mental disorders

Answer 2

• Masturbation
• Drapetomania (slaves wanting to be free)
• Dysaethesia aethiopica (slaves being lazy)

Question 3

Are disorders cross-cultural?

Answer 3

• To some extent, yes (ex. Schizophrenia, bipolar, depression)
• But there are cultural disparities
• Also “culturally-bound disorders” (ex. Koro (in Malaysia), windigo (in First Nations culture), anorexia (in Western cultures)

Question 4

Deinstitutionalization

Answer 4

• Previously: sanitorium, asylum, in-patient care
• Now: as institutionalization decreases, the prevalence of mental illness in homelessness and prison rise
• • Balloon theory: homelessness and prisons ballooning due to loss of long-term care

Question 5

DSM Editions

Answer 5

• DSM-I (1952) and II (1968): psychodynamic-heavy
• DSM-III (1980): Spitzer’s vision -> expanded, exhaustive
• DSM-IV (1994): expanded again; conflicts of interest -> many people who worked on it had ties to pharmaceutical industry
• DSM-V (2013): people who worked on it had to sign NDAs; major rewrites; a “living document”
• • Example of change: Gender Identity Disorder taken out, replaced by Gender Dysphoria Disorder (intense anxiety, depression, etc. that may be experienced by trans people)

Question 6

DSM-5

Answer 6

• provides an exhaustive classification system for every possible mental disorder
• Several purposes:
• • Guides treatment choices
• • Allows clinicians to communicate
• • Pleases insurance companies who require concrete diagnosis
• • To permit research (via categorization)

Question 7

DSM-5 Criteria: Major Depressive Episode

Answer 7

• fatigue, worthlessness, impaired concentration, thoughts of death/suicide, insomnia, etc. + depressed mood + loss of interest in things that previously gave you pleasure in a 2-week period
• not looked at in context (ie. doesn’t matter if you have symptoms because mom died)
• Symptoms cause impairment to social, occupational life, etc.
• Not attributable to a substance or other condition
• Cannot be explained by a schizoaffective, schizophrenic, etc. Disorder
• Never been a manic or hypomanic episode

Question 8

Psychiatric Stigma

Answer 8

• People have strong stigma against people with mental illness -> considered the “worst” kind of people
• Despite stigma, mental disorders rarely lead to violence and clinical prediction of violence is unreliable
• • Those with mental disorders are disproportionately more often the victims of crime than those non-mentally ill

Question 9

Why does psychiatric stigma matter?

Answer 9

• Negative effects of stigma often greater than negative effects of the disorder
• Health care professionals’ stigma: poorer treatment or worse outcomes
• People act wary to those they think are mentally ill
• Landlords less likely to rent, employers less likely to hire
• Negative portrayals in media

Question 10

3 levels of stigma

Answer 10

• Structural stigma: policies and practices of institutions in positions of power that systematically restrict the rights and opportunities for people living with mental illnesses (ie. Barring people with mental illness from working, etc.)
• Social stigma: describes the phenomenon of social groups enduring stereotypes about and acting against a stigmatized group
• Self-stigma: negative feelings about yourself; internalizing the stigma from society and your interpersonal groups