W1-T1 Conceptualisation of mental disorder Flashcards
How the conceptualisation of mental health has changed
describe the ways mental disorder is called and why words have their weight (value-laden) ?
Historically (before Freud) – madness
Mental illness - clinical
mental disorder - legal/admin construct
mental health problem/mental distress – acceptable alternative (not harsh)
mental health – popular use, used by WHO
why mental disorder synonym with legal construct?
used in legal acts – i.e
1983 Mental Health Act: mental disorder is any disorder or disability of the mind
The Crown Prosecution Service: uses the term ‘mentally disordered offender’ to describe
a person who has a disability or disorder of the mind and has committed, or is suspected of
committing, a criminal offence
What is not cosidered mental disorder according to Mental Health Act: Code of Practice
dependence on drugs and alcohol
what is the current law in identifying mental disorder in England & Wales
if 3 professional agrees that a mental disorder is present with other criteria, the person an be detained and treated against their will
why DSM 5 is criticized
intellectual blind alley (too narrow)
define mental disorder as admin construct
DSM 5
– Identify mental disorder
– count mental disorder
– Calculate mental disorder burden
– Assess specific services and benefits
– diagnostic function
the image of disorder
uncontroversial disorder - depression (all agree depression exists)
fashionable disorder - BPD
contested disorder - schizophrenia
mental disorder misuse
as an adjective – i.e. my OCD is coming, you look anorexic
inaccurate, demeaning, raise stigma
define mental health problem according to Mental Health Foundation
mental health problems range from worries we all experience as part of everyday life to serious long-term conditions.
what information does the term ‘mental health problem’ convey
careful about the use of language
there is spectrum of difficulties
avoids illness language
mental health construct according to WHO
Mental health is defined as a state of well-being in which every individual realizes his or her own potential can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community
downside to WHO approach to mental health
inclusive definition but focus on providing service to the ones with severe problems only
define positive mental health according to NHS
connect - with family/community/friends
be active - find an enjoyable activity to stick to
keep learning - will gain confidence
give to others - even just a smile
be mindful - aware of the present moment, thought/feeling
explanation of madness in ancient worlds
brain disorder
react to circumstance/moral weakness, failing
demonic possession
missing – spiritual domain
define psychological construct
associationism (based on Locke (1659), 18th and 19th C approaches to treatment
– Madmen do not appear to have lost the faculty of
reasoning; but having joined together some ideas very wrongly, they mistake them for truths and they
err, as men do that argue right from wrong principles
psychodynamics
– extremely influential in the 20th century, particularly in the US
– remains of great cultural importance and certainly still informs psychological treatments for personality disorder
cognitive behavioural approaches
– modern-day
– ‘individuals with persecutory delusions erroneously believe that others are trying to cause them physical,
psychological, or social harm. Our psychological conceptualisation is that at the heart of persecutory
delusions are unfounded threat beliefs (freeman, 2016)
what’s missing from psychological construct?
psychometric testing
assessment of cognitive functioning
structured risk assessment
–> important especially when dealing with complex phenomena
define characteristics of mental disorder as a brain disease
degeneration theories – dominated the late 19th century in a harmful way – sterilisation and merciful killing (euthanasia) for people with learning disability become public policies
general paralysis of the insane (GPI) (infection) / Alzheimer’s disease – clear neuropathology.
psychopharmacological revolution (the 1950s onwards) - remains important to contemporary psychiatric services
genetics and epigenetics - new discipline - currently
focus on an enormous amount of research with potentially important therapeutic implications
imaging and functioning imaging - still largely a research tool except for investigation of dementia
mental disorder and sociological approaches
begin in the late 19th century and onwards
Durkheim - suicide and linked it to the sociological construct of ‘anomie’
Goffman - ‘the total institution’ and its
effect on individuals– total institution being an asylum, but also a prison or monastery or nunnery.
Scheff - labelling theory
Goffman and Scheff have had a continuing influence on the ways we look at mental health and mental health services –
institutions bad things and deviant behaviours as the world is societally determined.
implicitly, that worldview denies reality to a disability, which is seen as a social phenomenon.
mental disorder and society: empirical approaches
- psychological stressors act as precipitants of illness
- childhood adversity/abuse
- immigration experience
- family environment
- stigma and outcome of mental disorder
- epigenetics -gene/environment interaction
models for mental disorder
the disease model
the cognitive behavioural model
the psychodynamic model
the social model
–>mental health professional synthesis these models in practice
frank holloway personal view on mental health disorder
complex phenomena
simplistic explanations are likely wrong
diagnostic and formulation helpful in making sense of problems and planning intervention
no single model is satisfactory
imply a biopsychosocial approach to psychiatry
