Topic 1 - The Historical Context of Mental Health

Question 1

Background

Answer 1

Demonic Possession
Humourism
Animalism
Moral Treatment

Question 2

Demonic Possession

Answer 2

A supernatural explanation of mental health

• Poor mental health signalled possessions by demons
• Demons could be ancestors, animals, gods or heroes
• Possession could be onset by lack of faith or the ‘cunning of the devil’.
• Trephinning (drilling holes into skulls) was used as a treatment, ie. releasing the demons

Question 3

Humourism

Answer 3

A somatogenic explanation of mental health
Hippocrates, c. 460 - 377 bc

Madness was a result of an imbalance in the four humours -

1. Blood - too much = Manic State
2. Phlegm - too much = Sluggish / dull
3. Yellow Bile - too much = Anexiety
4. Black Bile - too much = depression

Treatments included - blood letting, leeches, laxatives + purgatives

Question 4

Animalism

Answer 4

18th century somatogenic explanation of mental health.

Mentally ill people were treated like animals as their behaviour was disordered and wild.

Madness arose due to a person losing the capacity to reason.

Treatments included being chained to walls, whipped, shaving scalps, bleeding, blistering + purgatives/laxatives.

Question 5

Moral treatment

Answer 5

Developed by Phillipe Pinel, in charge of a mental assylum in France (1972).

He petitioned for patients to be freed from chains and allowed outside to excercise

This resulted in laws being changed to ban previous cruel treatments.

He believed that mental health was caused by social stress, cognitve conditions or physical injury.

He promoted the humane treatment of patients and friendly relationships between therapits and patients.

He also kept detailed case files.

Question 6

Definitions of abnormality

Answer 6

Rosenhan and Seligman (1984) developed four definitions of abnormality;

1. Statistical Infrequency
2. Failure to function adequately
3. Deviation from social norms
4. Deviation from ideal mental health

Question 7

Statistical Infrequency

Answer 7

Abnormality is not the statistical norm for society, for example;

Schiziophrenia = 1.45% in UK
Depression = 3.3% in UK

Critique of this - Not all abnormalities are negative or linked to mental health, eg. Usain Bolt, ‘abnormally’ quick.

Question 8

Failure to function adequately

Answer 8

Inability to live a normal life adequately
- Holding down a job
- Maintaining positive relationships
- Looking after oneself
- Interacting effectively in society

Critique of this - Inability to live alone may be due to otehr factors, eg. poor education, disability. Some people may have dangerous jobs / smoke

Question 9

Deviation from social norms

Answer 9

Going against behaviours that are deemed by society to be ‘normal’ and ‘acceptable’

Critique - Cultural / Generational differences, some people choose to be different.

Question 10

Deviation from ideal mental health

Answer 10

Ideal Mental Health - Positive Self-Image, Capable of growth, Independent thoughts, accurate perception of reality, cope with stress, maintain positive relationships

Critique - Happy may not always mean independent, Stress is hard to cope with, falling out people.

Question 11

Characteristics of the DSM-5 (4)

Answer 11

1. Types of Disorders - Separated into broad categories, eg. Anxiety disorders / Depressive Disorders.
2. Life Span Order - Begins with diagnoses prevalent in babies / young children
3. Internalising / Externalising - Symptoms are either expressed inwardly, eg. Self-harm (Internalising) or outwardly, eg. disruptive behaviour (Externalising)
4. Same information - Each disorder had a standardised set of information, eg. gender-related diagnositic issues, cultural information, prevalence + co-morbidity.

Question 12

Key Research

Answer 12

Rosenhan (1973) - On being sane in insane places

Question 13

Aim of Rosenhan’s study

Answer 13

To see if mental hospitals in the USA in early 1970s could tell the sane from the insane.

Question 14

Study 1 - Sample / Preparation

Answer 14

8 sane people (psudeo-patients)
12 different hospitals
Reported hearing an unfamiliar voices of the same sex saying ‘empty’, ‘hollow’ + ‘thud’.
On all occassions, they were diagnosed with schiziophrenia - except one manic-depressive psychosis.
Once admitted, they stopped reporting any symptoms.

Question 15

Study 1 - Main part

Answer 15

On average, they remained in hospital for 19 days.
They were discharged with Schiziophrenia in remission
35 / 118 - raised suspicions regarding the experimenters’ sanity.
Their behaviours were misinterpreted, eg. note-taking was viewed as a symptom.
Attendents only spent 11.3% of time outside ‘the cage’
Total time that patients spent with psychologists was 6.8 minutes on average.

Question 16

Study 1 - Experiment

Answer 16

In 4 of the hosptials, the pseudopatients asked staff members simple questions, eg ‘pardon me, X, could you tell me when I will be presented at the staff meeting’

They recored how staff responded to this question.

This was compared with a study done at Stanford Uni, eg. “Could you direct me to Encina Hall?”

Question 17

Study 1 - Experiment Findings

Answer 17

In the mental hospital, 71% of psychiatrists moved on with heads averted, compared with 0% at the Uni / Medical Centre.

Question 18

Study 2 - Procedure

Answer 18

One hospital became aware of the first study and requested psuedopatients to be sent to their hospital.

They were informed that 1+ psudeopatients would be admitted and staff were asked to rate every new patient on a 1-10 scale, how likely they were to be a psudeopatient.

No Pseudopatients were sent

Question 19

Study 2 - Findings

Answer 19

19/193 patients were judged to be pseudopatients by one staff member + one psychiatrist.

Question 20

Conclusions from Rosenhan’s study (3)

Answer 20

Mental Hospitals in the USA in the early 1970s were not very good at making valid or reliable diagnoses.

The ‘Stickiness of psychodiagnostic labels

Patients were often treated with profound disrespect.

Question 21

Charactersitics of affective disorders (depression)

Answer 21

DSM-5

Major Depressive episode, with 5+ symptoms in the same 2 week period, including symptom 1 or 2.

1. Depressed mood, most of the day, nearly everyday
2. Diminished interest
3. Body weight loss - >5%
4. Insomnia
5. Restlessness
6. Fatigue
7. Feelings of worthlessness
8. Lack of ability to think
9. Reccuring thoughts of suicide.

Symptoms should not be attributable to any other cause, eg. another disorder

Question 22

Charactersitics of a psychotic disorder (Schiziophrenia)

Answer 22

DSM-5

Two or more of the following must be present during a month period. One of symptoms 1,2 or 3 must be present.

1. Delusions
2. Hallucinations
3. Disorganised speech
4. Grossly disorganised behaviour
5. Diminished emotional expression

Question 23

Characteristics of an anxiety disorder (agoraphobia)

Answer 23

DSM-5

Marked fear or anxiety about 2 or more of the following situations;

1. Using Public Transport
2. Being in open spaces
3. Being in enclosed spaces
4. Standing in line or a crowd
5. Being away from home

Fear must be out of proportion to danger, and these scenarios must almost always provoke an anxiety attack. The fear/avoidance must persist for 6 months and have no other causes.