The Historical Context Of Mental Health

Question 1

Rosenhan aim

Answer 1

Testing the reliability of diagnosis of mental disorders

Question 2

Rosenhan experiment one ppts

Answer 2

12 hospitals over 5 states. Mixture of old and new facilities with different staffing levels. 1 was private.

Question 3

Rosenhan experiment 1 procedure

Answer 3

Pseudopatients ring admissions office saying they could hear the words “empty, hollow, thus” in a voice they didn’t recognise that was the same gender as them. Fake names, addresses and jobs but being for real about everything else. Once admitted they acted normally with no more mentions of symptoms. Did everything asked of them besides swallowing pills, but kept note of everything that happened on the ward. Could only leave when discharged.

Question 4

Rosenhan experiment 1 results

Answer 4

11 admissions for schizophrenia, one for bipolar disorder.
All detected by staff as being sane.
Pseudopatients stayed for 7-52 days, 19 days on average.
Discharged as schizophrenic in remission.
Other patients said “you’re not crazy”, and “you’re a journalist, or a professor”.
Queuing early for lunch was described as “oral acquisitive syndrome”.
Making notes was seen as obsessive writing behaviour.

Question 5

Rosenhan experiment 1 conclusions

Answer 5

Bias towards false positive (type 1 error) - calling a healthy person sick.

Question 6

Rosenhan experiment 2 procedure

Answer 6

Staff at a research and teaching hospital doubted Rosenhan’s findings and believed they would identify pseudopatients.
Staff were falsely informed that over the next 3 months, they would meet at least 1 pseudopatient.
Staff were asked to rate on a scale of 1-10 (1 = high confidence) each patient on the likeliness of them being a pseudopatient

Question 7

Rosenhan experiment 2 results

Answer 7

Over the 3 months, 193 patients were admitted.
At least one staff member rated 41 patients as highly confident they were a pseudopatient.
23 were rated highly confident by at least one psychiatrist.
19 were rated highly confident by a psychiatrist and one other member of staff.

Question 8

Rosenhan experiment 2 conclusion

Answer 8

Suggests massive errors can be made in diagnosis
And it is just as easy to make a type 2 error by judging a sick person as healthy
Perhaps due to staff being told there would be pseudopatients, causing bias

Question 9

Extra Rosenhan context about staff avoiding patients

Answer 9

Average amount of time spent by attendants outside their work room was 11.3% of their shift (me spending my whole shift on a “quick” vape break)
Doctors and psychiatrists left their offices 6.7 times per day on average
Staff tended to only leave to reprimand, administer medication or therapy, or attend a patient conference.
As if “the disorder is somehow catching” - Rosenhan

Question 10

Stickiness of labels in Rosenhan

Answer 10

One pseudopatient was closer with his mother than his father as a child, but this reversed in adolescence. He also was close with his wife and didn’t hit his children. The clinician wrote he had a “long history of considerable ambivalence in close relationships”, making normal behaviours sound unusual. Once diagnosed they could not escape being viewed through the lens of their diagnosis.

Question 11

How did Rosenhan find wards made patients feel powerless

Answer 11

Could be punished verbally or physically
Lost legal rights
Possessions and case notes seen by all
Monitored while bathing or using the toilet
Patients were discussed as if they weren’t there

Question 12

How did Rosenhan find patients were depersonalised

Answer 12

Lack of interaction with staff
Nobody cared whether medication was taken or not
Staff opened ignored them when they spoke or talked about them as if they weren’t there

Question 13

Procedure for Rosenhan’s 3rd experiment (comparison study)

Answer 13

In 4 hospitals, a pseudopatient approached a staff member asking a question such as “Pardon me, Dr X, could you tell me when I will be eligible for grounds privileges?”. Data was also collected for a young woman asking a faculty member for assistance, and a university medical centre.

Question 14

Who were the pseudopatients

Answer 14

8 of them - 3 women and 5 men. Included psychologists, a painter and a housewife.

Question 15

Results for Rosenhan’s 3rd experiment

Answer 15

In Stanford university 100% of ppts stopped and talked.
Nurses responded to pseudopatients 0.5% of times and psychiatrists 4%. Most didn’t even make eye contact.

Question 16

Hippocrates explanation of mental illness

Answer 16

Around 500BC
Hippocrates was an Ancient Greek physician
First to identify that mental illness may be scientific rather than supernatural or religious
Believed illness came from an imbalance in the 4 humours - blood, phlegm, black bile and yellow bile.
Treatments included bloodletting, laxatives and diets.

Question 17

Trepanning information

Answer 17

Happened as early as 6500BC
Demons / evil spirits thought to cause mental illness
Cave art and skulls show evidence for surgical drilling to treat epilepsy, head injuries and release evil spirits

Question 18

Moral treatment of mental illness

Answer 18

18th and 19th centuries
Protests were growing over the conditions in which the mentally ill lived
“Enlightenment thinkers” suggested a more humane view, referred to as “moral treatment”. Made environment more comfortable through kindness, walks and having decorations.

Question 19

4 definitions of abnormality

Answer 19

Statistical infrequency
Deviation from social norms
Failure to function adequately
Deviation from ideal mental health

Question 20

Statistical infrequency explanation and evaluation

Answer 20

Behaviour is abnormal when it is statistically rare
People who are 2 standard deviations above or below the mean are abnormal
+ objective
+ easily calculable
- arbitrary numbers, made up therefore potentially meaningless
- not all rare behaviours are abnormal and not all common behaviour are normal
- statistics could be incorrect or unreliable
- what is rare in one culture may be common in another

Question 21

Deviation from social norms explanation and evaluation

Answer 21

Every society has rules about what are abnormal behaviours / values / beliefs
Behaviour is dysfunctional is it deviates from what society’s deems acceptable
+ easy to identify as we notice when people behave in an abnormal manner
- differs across cultures
- normal behaviours change over time
- some people like the Suffragettes challenged social norms. If they had been classed as mentally ill their rights could have been taken from them.
- committing minor criminal offences may be against societal norms, but people regularly do it

Question 22

Failure to function adequately explanation and evaluation

Answer 22

If a person is unable to live independently, because their behaviour is counter productive, they may be abnormal.
Behaviour that prevents people from working or caring for themselves are considered dysfunctional.
+ takes into account observer discomfort, as the individual themselves may not feel distressed
- subjective, as we have to define “functioning” and “adequate”
- may differ between cultures
- many normal girls have flop eras where they fail to function adequately (vaping, failing to attend classes, struggling to sleep etc)

Question 23

Deviation from ideal mental health explanation and evaluation

Answer 23

Determines if the behaviour the individual is displaying is affecting their mental well-being
Marie Jahoda said ideal mental health consists of
1. A positive attitude to oneself
2. The opportunity to self-actualise (achieve potential)
3. Ability to resist stress
4. Autonomy; being independent and self regulating
5. An accurate perception of reality
6. The ability to adapt to ones environment

+ only definition which attempts to define normal
- “ideal” is subjective
- criteria is very demanding, lots of people won’t meet all requirements
- ethnocentric; ideals may fit individualistic counties more than collectivist ones

Question 24

International Classification of Diseases

Answer 24

Created by the World Health Organisation
ICD 11
Used globally
Only chapter 5 is about mental disorders

Question 25

Diagnostic and Statistical Manuel

Answer 25

Published by American Psychiatric Association
DSM 5
Exclusively for mental health
Contains descriptions, symptoms and other criteria for diagnosing mental disorders
Homosexuality was listed as a disorder until 1986
Internet Gaming Disorder was added in 2013
Removed subtypes for autism and schizophrenia in 2013
69% of people on the board to approve DSM 5 had links with pharmaceutical companies (biased)

Question 26

Advantages of categorisation tools

Answer 26

Standardises diagnosis over different treatment providers
Can help aid research
Should be valid
High temporal validity - disorders change with time (homosexuality in 1986 and internet gaming disorder in 2013)

Question 27

Disadvantages of categorisation tools

Answer 27

May be reductionist - oversimplifying complex human behaviour
Risk of over-diagnosis as thresholds have been lowered
Biased - 69% on board for DSM 5 had links to pharmaceutical companies
Less useful - doesn’t identify treatment
Not reliable - Spitzer and Fleiss found Kappa agreement mean of 0.52, so no category has consistently high agreement in diagnosing patients
Gender bias - Ford and Widge found changing the gender of patient could change diagnosis from antisocial personality disorder to histrionic personality disorder
Ethnocentric - one cultural perspective
Stickiness of labels

Question 28

Characteristics of an affective disorder

Answer 28

Depression
DSM 5 : 5 or more symptoms within the same 2 week period, at least one of which being depressed mood or loss of interests
- depressed mood most of the day nearly every day
- diminished interest in most activities
- weight loss or gain
- slower thoughts and movements
- fatigue
- excessive guilt / feeling worthless
- being indecisive or struggling to concentrate
- thoughts of suicide

Question 29

Characteristics of psychotic disorders

Answer 29

Schizophrenia (DSM 5)
- delusions
- hallucinations
- disorganised speech
- disorganised or catatonic behaviour
- decreased motivation and diminished expressiveness
- diminished functioning in work, relationships, or self-care
- other disorders such as bipolar ruled out
- not the effect of a drug

Question 30

Characteristics of an anxiety disorder

Answer 30

Agoraphobia (DSM 5)
Fear of anxiety about 2+ of these situations
1. Using public transport
2. Being in open spaces
3. Being in enclosed spaces
4. Standing in a line or a crowd
5. Being outside or home alone

• situations almost always cause an anxiety attack
• fear isn’t in proportion to danger
• fear persist for more than 6 months
• impairs functioning - requires companion or avoids situation
• no other causes