Sociocultural Psychiatry Flashcards
What is the social classification in Britain?
Class 1: Professional, managerial Class 2: Intermediate Class 3: Skilled, manual, clerical Class 4: semi-skilled Class 5: unskilled Class 6: unemployed
Which psychiatric disorders are not as common in lower social classes?
Anorexia
Alcohol abuse
Bipolar
What is the Jarman Index?
Scoring system for level of social deprivation in a community.
Who created the concept ‘sick role’?
Talcott Parsons
What makes up the sick role?
Sick person is exempt from normal social roles.
Sick people are not responsible for their disease.
Sick person must try and get well.
Sick person must seek help and cooperate with care.
What is the difference between illness and sickness?
Illness: personal experience
Sickness: social consequences
Define impairment
Interference with structural or psychological functions
Define disability
Interference with activities of the whole person in relation of immediate environment.
Define handicap
Social disadvantage resulting from disability
What does the Transtheoretical Model (Prochaska and DiClemente) state?
How individuals can change illness-related behaviour:
- Consciousness raising (help them gather info)
- Choosing - increase awareness of alternatives
- Catharsis - emotional expression of problem behaviour
- Conditional stimuli
- Contingency control - positive reinforcement + self-appraisal
What is conditional stimuli in the Transtheoretical Model?
Stimulus control - avoidance of stimuli associated with problem behaviour
Counterconditioning - training a healthier response to stimuli.
What are the six stages of change under the Transtheoretical Model?
- Precontemplation
- Contemplation
- Preparation
- Action
- Maintenance
- Relapse
Who created Motivational Interviewing?
Miller & Rollnick, 1991
Define health advocacy
Process of supporting and empowering patients and carers to express their opinions, ideas and concerns and enabling them to access appropriate information and services and promote their rights.
What is the libertarian principle in resource allocation?
Resources distributed according to market principle - patient as consumer, if they can pay then resources are available to them.
What does utilitarian principle suggest towards resource allocation?
Resources distributed according to maximum benefit to all
Which principle suggests resources should be distributed according to need?
Egalitarian
What does restorative principle suggest in terms of resource allocation?
Resources distributed with positive discrimination towards disadvantaged.
Outline the stages of the family cycle
Stage 1: formation of family
Stage 2: child rearing (birth to adolescence). Maintain marital relationship.
Stage 3: child launching - child leaves home.
Stage 4: return of independence - growth and extension of family.
Stage 5: dissolution - decline/demise of partners.
What are the schizophrenogenic family patterns according to Lidz?
Marital schism
Marital skew
What is marital schism?
Family is in disequilibrium due to repeated threats of parental separation. Parents downgrade roles of each other.
What is marital skew?
Family is at an equilibrium that is skewed and achieved at an expense of the distorted parental relationship.
What did Wynne suggest re families and schizophrenia?
Certain types of communication may be more present:
Pseudo-hostility + Pseudo-mutuality
Child forced to accept and develop communication that will negate and deny existence of meaningless relationships in the family.
What is the double-bind relationship?
Bateson: superficial verbal communication contradicts behavioural and deeper communication amongst family. These mixed messages keep child in a double bind that increases risk of psychosis.
Who coined the term schizophenogenic mother?
Freida Fromm-Reichmann
What is the schizophenogenic mother?
Rejecting, impervious to feelings of others, rigid in moralism re sex and fear of intimacy.
Who created the concept of expressed emotions?
Brown & Rutter (1966)
What are the measures for expressed emotion concept?
Critical comments Positive remarks Emotional over invovement Hostility Emotional warmth
Which components of the expressed emotions measures were most predictive of schizophrenia?
Over-involvement
Critical comments
Hostility
What is the Camberwell Family Interview?
Individuals of family interviewed + patient.
If one relative is classified as high expressed emotion, then whole family could be classified as such.
Who created the Life events and difficulties schedule?
Brown and Harris
What is the Life events and difficulties schedule?
Life events are graded according to their meaning for the individual.
What are some semi-structured ways of measuring life events?
Life events and difficulties scale
Interview for recent life events (Paykel)
What are some life event scales?
Social readjustment rating scale (Holmes and Rahe)
Adverse childhood events scale
Hassles & uplifts scale (Lazarus and Folkman)
Who created the biopsychosocial approach to psychiatry?
Engel
Who suggest the social drift/social selection theory for MH probems?
Faris and Dunham
According to Rutter, which risk factors in family environment correlate with childhood MH problems?
Severe marital discord Low social class Large family size Maternal MH disorder Paternal criminality Foster placement
Who used the terms primary/secondary deviance to explain the process of labelling mh problems in society?
Edwin Lemert
What is primary deviance?
General aberration from normality before person is identified as deviant.
What is secondary deviance?
Deviance in someone labelled as deviant by institutions such as society/criminal justice system.
What are the types of suicide according to Durkheim?
Altruistic
Egoistic
Fatalistic
Anomic
What is altruistic suicide?
Individual is overly attached to social norms and dies for society
What is egoistic suicide?
Excessive individualism but low social integration.
What is fatalistic suicide?
Society’s control on the individual is so strong that it interferes with moral values and personal goals.
What is anomic suicide?
Individual feels he has no guidance or regulations from society.
What are the vulnerability factors for depression according to Brown and Harris (1978)
Absence of close confiding relationship
Loss of mother before 11 years of age
Lack of employment outside home
3 or more children under 15 living at home.
What does the social defeat hypothesis state?
Long-term experiences of social disadvantage lead to sensitization of the dopamine system and increased baseline activity of this system. This increases the risk of schizophrenia.
What does the notion of prepsychotic segregation state?
Individuals who are psychosis prone find it hard to survive in countries of birth and therefore immigrate.
What was Goffman’s definition of total institution?
One whose character is symbolized by the barrier to social intercourse with the outside.
What are the stages of Goffman’s ‘moral career’
Betrayl funnel
Role stripping
Mortification
Privilege system
What is the betrayl funnel in the moral career?
People we trust conspire against un when we are unwell and report us to Healthcare professions (circuit of agents).
What is the role stripping part of the moral career?
Institutionalised process begins with assaults on the persons self, such as trading personal belongings for hospital materials.
What is mortification in the moral career?
Series of assaults on the persons self-image. E.g. private activities are on public display, person must ask permission. Also called civil death.
What is privilege system according to moral career?
The individual is inserted into the lowest rung of the privilege system, based on house rules. Freedom is a token of reward.
What is binary living in institutions?
Lives of the staff are in contrast due to power, connection with the outside world and ability to change their lives as they wish.
What are secondary adjustments according to Goffman?
Habitual arrangements used by patients who act as if their concern is to escape the institution.
Who used the term institutional neurosis?
Russel Barton - 1976
What is institutional neurosis?
Characterized by apathy, lack of initiative and interest and submissiveness.
What is clinical poverty?
When social poverty and lack of stimulation are related to the severity of blunted affect, poverty of speech and social withdrawl in schizophrenia.
Define penology.
Societal response and treatment of crime and criminals.
What is enacted stigma?
Patients actual experience of discrimination
What is courtesy stigma?
Stigmatization of someone related to an individual with that problem (e.g. MH)
What are the themes of stigma according to Hayward and Bright?
Dangerousness
Attribution of responsibility
Poor prognosis
Disruption of social interaction
What was Hagighat’s theory of stigma?
Stigma serves the self-interest of stigmatisers in four ways: Constitutional Psychological Economic Evolutionary
What is the constitutional aspect of Hagighat’s theory of stigma?
Quick and easy stereotypes at the expensive of depth. Human brain prefers negative evaluations to positive.
What is the psychological aspect of Hagighat’s theory of stigma?
Human tendency uses the example of the unfortunate other to feel happier towards themselves.
What is the economic aspect of Hagighat’s theory of stigma?
To increase ones access to resources, stigmatisation is used as a weapon for competition.
What is the evolutionary aspect of Hagighat’s theory of stigma?
Stigma provides an evolutionary advance - e.g. avoiding such discriminated population from being chosen as sexual mates.
What are the dimensions of stigma according to Jones?
Concealability Course - if it is reversible Disruptiveness - of interpersonal interactions Aesthetics Origin - is it causal? Peril - feeling of danger
What is Corrigans theory of stigma?
Three components:
Stereotypes
Prejudice
Social discrimination
What is Link and Phelan (2001)’s theory of stigma?
Labelling
Stereotyping - based on dominant cultural beliefs to group people
Separation
Status loss and discrimination
What is Liz Sayce’s model for addressing stigma?
Brain disease model
Individual growth model
Libertarian model
Disability inclusion model
What is the brain disease model in stigma?
MH is an illness like any other and is no ones fault. This can be paternalistic.
What is the individual growth model in stigma?
MH as a spectrum, including good MH.
What is the Libertarian model in stigma?
Advocates for equal rights for MH patients.
What is the disability inclusion model for stigma?
Promotes concept of social inclusion on civil rights grounds.
Who created social role valorisation?
Wolf Wolfensberger - 1983
What is social role valorisation?
Creating social roles for devalued people to enhance their competencies.
What is the emic perspective?
The perspective of an individual about their own cultural group.
What does the etic perspective assume?
Universality of illness
Invariance of core symptoms
Validity of diagnostic constructs
Define ethnicity
A set of cultural patterns (values, beliefs, roles), heritage or ancestry shared by a social group of common national or geographic origin.
What are the types of acculturation according to Berry?
Integration
Separation
Assimilation
Marginalisation
What does assimilation mean in Berrys model of acculturation?
High degree of adoption of new culture
Low degree of retention of culture of origin
According to Berry’s model of acculturation, what is the type when someone has a high degree of retention of their cultural origin but low degree of adoption of the new culture?
Separation
What type of acculturation leads to a risk of MH problems?
When someone loses their culture of origin voluntarily but does not assimilate or integrate.
What is enculturation?
Culture being learnt through contact with family, friends, media etc.
What is melting pot according to Berry’s method of acculturation?
High degree of relationship among various cultures
Low degree of retention of individual culture identities
What is segregation according to Berry>
Low degree of relationship among various cultures in society
High degree of retention of individual culture identitites
What is cultural diffusion/syncretism?
Spread of cultural traits through contacts accross society.
What is sojourning?
Voluntary but brief exposure to different cultures.
What are Goffmans 5 types of segregation?
Incapable harmless - orphanages Ill but threat to society - MH hospitals Not ill, threat to society Occupation related - boarding schools Retreat from world - monasteries
How can psychiatry see culture?
Explanatory
Pathoplastic
Diagnostic
Service instrument
What is culture as an explanatory tool?
Allows description of non-pathological behaviours in context of culture
What is culture as a pathoplastic agent?
Description of psychopathology that results from cultural practices.
What is culture as a diagnostic factor?
Allows culture-specific, unique diagnostic framework
What is culture as a service instrument?
Allows utilization of cultural knowledge in service delivery
What is an idiom?
Well-structured, codified way of expressing thoughts via language.
Cannot be translated as they lose meaning.
What are idioms of distress in Psychiatry?
Somatic symptoms that serve as a code for expressing ones mental distress in some cultures.
Models of care in cultural psychiatry
Ethnic minority - services for minorities only
Cultural consultation
Melting pot model
A hedge-your-bets approach
What is the cultural consultation model?
Specialized MDT which gives consultations to clinical teams and families - no direct patient care.
What is the melting pot model?
Institutional factors promoting inequality are addressed. Thus, mainstream services are enriched by responding to all cultural needs.
What is a hedge-your-bets approach in cultural psychiatry?
Both prescribed medication and ethnic, spiritual therapy may be best hope for securing adherence.
What type of illness is amok?
Dissociative
Where is amok common?
Malaysia, Laos, Philippines, Papua New Guinea, Puerto Rico
What happens in amok?
Sullen period, then outburst of violence, return to premorbid state.
What is ataque de nervios?
Attack of distress - sudden shouting, crying, dissociation - leading to sense of being out of control. May have LOC/amnesia afterwards.
Related to acute stress.
Sense of heat arising from chest into head.
Where is berdache common?
North America
What is berdache?
Male who has assumed female gender role
What is Bouffee delirante?
Sudden outburst of agitated and aggressive behaviour, confusion.
What is Bouffee delirante common?
West Africa
Haiti
What is brain fag?
Difficulty concentrating, thinking, remembering.
Where is brain fag seen?
West Africa
What is dhat?
Anxiety and hypochondria relating to seminal discharge accompanied by feeling weak and exhausted.
What is another name for dhat?
Shenkui in China
What is Frigophobia?
Fear of feeling cold/wind due to yin-yang imbalance.
What is Koro?
Eoisode of sudden, intense anxiety that penis/vuvla/nipples will recede into body and possibly cause death.
Where is Koro common?
Malaysia
SE Asia
Where is Latah common?
Malaysia
SE Asia
What is Latah?
Hypersensitivity to sudden fright, with echopraxia, echolalia, command obedience and dissociative behaviour in middle-aged women
What is mal de ojo?
Mediterranean concept of evil eye affecting children with physical symptoms
Where is Nerfiza/nevra common?
Egypt
Greece
Central America
What happens in Nerfiza?
Chronic episodes of extreme sorrow/anxiety, inducing somatic complaints.
Where does Piblokto occur?
Arctic Eskimo communities
What happens in Piblokto?
Dissociative episode with excitement followed by seizure/coma lasting up to 12 hours.
May be withdrawn/amnesia afterwards.
What is shinkeishitsu
‘Nervous traits’ in Japanese.
Syndrome of obsessions, perfectionism
What is susto?
Attributed to a frightening event that causes soul to leave body resulting in unhappiness
What is Tajin-kyofu-shou?
Fear of losing good will of others due to imagined shortcomings of oneself.
Where is Ufufuyane/amafufunyane seen?
Kenya
South Africa
Bantu
Zulu
What is Ufufuyane?
Anxiety state attributed to effect of magical potions of spirit possessions.
Sobbing, paralysis, LOC, nightmares with sexual themes,
What is Windigo?
Intense craving for human flesh
Where is Windigo seen?
Algonquian Indian cultures
What are Tseng’s different effects of culture on psychopathology?
Pathogenic Pathoselective Pathoplastic Pathoelaborating Pathofacilitative Pathoreactive
What is pathoselective?
Tendency to select certain culturally influenced reactions
What is pathoplastic?
Culture influences manifestations of MH illnesses such as delusions.
What is pathoelaborating?
Universal behavioural reactions that are selectively reinforced by a culture.
What is pathofacilitative?
Cultural beliefs affect frequency of onset by facilitating risk factors.
What is pathoreactive?
Culture affects treatment, stigma and outcome.
Who coined the term anti-psychiatry and when?
David Cooper
1960s
Who proposed that mental disorders are learned abnormalities of behaviour?
Eyseneck, 1968
What is the hidden meaning model?
Irrational behaviours deemed symptoms are meaningful for patient.
Who coined descriptive psychopathology?
Karl Jaspers
What is explanatory psychopathology?
Assumes causative factors based on theoretical constructs.
What is descriptive psychopathology?
Understanding human experience through description of what is observed.
What are the components of descriptive psychopathology?
Observation
Empathetic assessment of subjective experience - phenomenology
What is ostensive in phenomenology?
Illustrating a concept by clinical experience - defining by examples
What is conventional in phenomenology?
Defining a concept using conventional description such as legal definitions
What is persuasive in phenomenology?
Deliberate employment of a term to persuade users to employ it in a specific manner
What is declarative in phenomenology?
Formal explanation of significance of a word or its parts as used in dictionaries
What is contextual in phenomenology?
Defining a concept by context in which it occurs
What is ‘essential’ in phenomenology?
Defining nature of an object
What is the first attempt in coding ethics in medicine?
Chakara
What is Chakara’s principle of ethics?
Friendship
Sympathy towards the sick
Interest in cases according to ones capabalities
No attachment to patient after recovery
Name some higher order principles in ethics
Deontology
Teleology
What is Deontology?
Centrality of rules in governing medical practice.
Rights and duties determine action - thus this si absolutism.
In what way can duties be right under ethics?
Prima facie - by their nature
Duty proper - by their cicumstances
What is Teleology?
Based on peoples interests, such as needs and desires. i.e. benefit vs harm.
The right action is the one that has the best foreseeable consequences.
What are the forms of utilitarianism?
Act utalitarianism - deals with a specific act
Rule utilitarianism - deals with general practices
Who pioneered the prima facie/four pillars of ethics?
Tom Beauchamp
James Childress
Raanon Cillon
What is the interpretive model of medicine?
Doctor will treat patient for a long time and will get to know the patient well and understand their circumstances - shared-decision making.
What is the deliberative model in medicine>
Doctor may act as counselor to patient - information is given alongside advice.
What is direct ethics?
To determine ethical behaviour we should look at the act
What is indirect ethics?
Ethics is about the actor - formation of character
What is pragmatic ethics?
Emphasis on success/reaching a goal with little concern on how this is achieved
What is humanistic ethics?
Emphasis on what is best for society.
What is the golden mean of Aristotle?
Ethical behaviour lies between extremes between excess and deficiency.
What is the Nuremberg Code 1974?
Code of ethics following Nuremberg trials post WWII re doctors experimenting on people.
What does the Nuremberg code state?
Human experimentation can only be carried out if:
there is voluntary consent
research is for common good of society
avoidance of unnecessary pain/suffering is guaranteed
subject has liberty to withdraw at any point
qualified researchers undertake research
scientists must terminate study if more harm is being caused than expected to subjects
What is the Declaration of Geneva 1948?
Reaffirmation of humanitarian aims of medicine by World Medical Association. Modification of Hippocratic oath.
What was the intention of the Declaration of Geneva 1948?
Highlight dedication of medical profession for cause of humanitarian goals.
What is the Declaration of Helsinki 1964?
Addresses clinical research, reflecting changes in medical practice from the term human experimentation used in Nuremberg code.
What was the Tuskegee Syphilis study (1932-1972)
US public health service following up 600 low-income african american males, 400 of whom were infected with syphilis but were not informed. Furthermore, some were not offered the treatment of penicillin.
What report was published as a result of the Tuskegee Syphilis study?
Belmont Report
What does the Belmont Report say?
Respect for persons
Informed consent should be obtained via full information + ability to withdraw at any time
During research, beneficial effects must outweigh harm causes with systematic assessment of this carried out beforehand
What was the Willowbrook School study (1963-1966)
Mentally handicapped children were deliberately infected with hepatitis after parents gave consent for what they thought were vaccinations.
What was the Jewish Chronic disease hospital study?
Studies to develop information about the nature of human transplant rejection; chronically ill patients w/o cancer were injected unknowingly with cancerous human liver cells.
What was the Tearoom Trade study?
During the 1960s, Laud Humphries (sociologist) followed up men who had anonymous sex in public places by tracing their number plates after befriending them.
