W1-T2 Mental Disorder and its Critics Flashcards
mental illness construct
not everyone comes into contact with mental health service fits the illness label well
define mental illness
‘The main claim of the physical approach, that is the assumption that mental disorders are dependent on physiological changes, is that it is a useful working hypothesis. It has made great advances and looks like making more (Slater, 1954)
The name “mental illness” implies disease. An illness suggests something wrong that is fundamentally different from normal function and is not just a variation in the degree (Tyrer, 1998)
making a psychiatric diagnosis using DSM
it is like a recipe book where you need to know what the ingredients mean
example to diagnose alcohol intoxication
- recent drinking of alcohol
- identify any problematic behaviour/psychological changes from drinking
- identify if symptoms and signs develop after alcohol use (only 1 required)
- make sure symptoms did not attribute to another medical condition?
What Szasz (1961) criticizes about mental illness in his manifesto in 1998
‘mental illness is a metaphor (metaphorical disease).
The word ‘disease’ denotes a demonstrable biological process that affects the bodies of living
organisms (plants, animals, and humans). The term ‘mental illness’ refers to the undesirable
thoughts, feelings, and behaviours of persons. Classifying thoughts, feelings, and behaviours as
diseases is a logical and semantic error, like classifying a whale as a fish. As the whale is not a
fish, mental illness is not a disease. Individuals with brain diseases (bad brains) or kidney diseases
(bad kidneys) are literally sick. Individuals with mental diseases (bad behaviors) like societies
with economic diseases (bad fiscal policies) are metaphorically sick. The classification of (mis)
behavior as illness provides an ideological justification of state-sponsored social control as medical
treatment.
R.D. Laing (67) criticism of mental illness
Madness need not be all breakdown. It may also be a breakthrough. It is potential liberation and renewal
as well as enslavement and existential death.’
—- he is extremely influential on a generation of psychiatrist
—- possibly better characterized as Existential Psychiatrist
What was the purpose of Critical Psychiatry Network (CPN)
build on the ideas of anti-psychiatrist (bring Science and Laing together)
Define CPN concerns about psychiatry
– heavily dependent on diagnostic classification and psychopharmacology
– Recognition of the poor establishes the validity of diagnoses
– sceptical about the efficacy of the psychiatric drug
– the use of psychiatric diagnosis to justify civil detention
– promote the study of interpersonal phenomena
post psychiatry according to (Bracken & Thomas, 2005) subtitled Mental Health in a Postmodern World
is philosophically-informed.
It emphasises hermeneutics and tells us, ‘human reality is something open, full of potential, and unyielding to formulae or models. Meaning cannot be fixed.
Central to hermeneutics is context.
this is an intellectually intriguing perspective,
not obviously conducive to care-planning
describe the Big Pharma and Medical Model criticism
the medical model of mental disorders is dependent on the pharmaceutical industry
suppressing negative study (i.e. efficacy of antidepressant)
encourage of new disorders and over diagnosis (ADHD and paediatric bipolar disorder)
describe Kinderman (2014) A Prescription for Psychiatry views
he rejects psychiatric diagnostic classificatory systems
‘is a manifesto for an entirely new approach to psychiatric care; one that offers care rather than
coercion, therapy rather than medication, and a return to the common sense appreciation that
distress is usually an understandable reaction to life’s challenges
why Frank Holloway think Kinderman set up a false antithesis
while he rejects the diagnosis in favour of formulation, in reality, the formulation-based psychological therapies that he advocates have been developed on the basis of diagnostics-equivalent constructs, such as anxiety, psychosis, delusions
define Frank Holloway arguments on mental illness
– appropriate for certain mental disorders (i.e. psychotic episode severe obsessive-compulsive disorder) – look like illness
– differences between mental and physical illnesses have been exaggerated
– positive value in diagnosis as an agenda for action
–diagnosis has a specific meaning– now this should not be over-interpreted
Toolkit in understanding mental disorder
Nosology (study of disease) - DSM 5 is the latest attempt to outline mental disorders (flawed)
Phenomenology - the philosophical study of the structure of experience and consciousness, in a structured way, the experiences and behaviours of a person
descriptive psychopathology -describes and categorises the abnormal experience as recounted by the patient and observed
How the toolkit can be improved
Psychometric testing –exploring constructs such as personality disorder, learning (intellectual) disability, and cognitive impairment
Structured Assessment – in relation to specific diagnoses– for example, the diagnosis of autism.
Neuroimaging – only mainstream for neuropsychiatric disorder
Forensic Practice – significantly reliant on structured risk assessments, not in diagnostic tools for understanding problematic behaviours and care planning
