Treatment 2: Electroconvulsive therapy (ECT)
EXAM 3: APPLIED PSYCHOLOGYISSUES IN MENTAL HEALTH38976304860290001173213309401Component 1: Historical context of mental healthBackgroundHistorical views of mental illnessDefining abnormalityCategorising mental disordersKey researchRosenhan (1973) On being sane in insane placesApplicationCharacteristics of an affective, psychotic and anxiety disorderComponent 2: Medical Model (as an explanation for mental illness)BackgroundBiochemical explanationGenetic explanationBrain abnormality explanationKey researchGottesman (2010) Disorders in offspring with two psychiatrically ill parentsApplicationBiological treatment of one specific disorderComponent 3: Alternative explanationsBackgroundBehaviourist explanationCognitive explanationHumanistic or psychodynamic explanationResearch:Szasz (2011) The Myth of Mental IllnessApplicationNon biological treatment of one specific disorderComponent 1: Historical context of mental healthBackground: Historical views of mental illnessWhat is mental health?A person’s condition with regard to their psychological and emotional well-beingMental health statistics1 in 4 British adults are diagnosed with at least one mental health problem each year. Key words: diagnosed, and at least one, and each year. Is this statistic really representative of mental health?The diagnosis rate 60 years ago was 1/100. What does that suggest about mental health? Is it getting worse?75% of all suicides are maleWhy do you think this is?Mental health throughout the ages5179060196215001550 BC: Ancient Egyptian medical records demonstrate an understanding of depression. Evil spirits were trapped inside individuals and this is what caused mental illnessesright41377300Treatments included spells, exorcisms and trepanation – drilling a hole through skull to allow evil spirits to ‘escape’This was used all the way up to the 1800’s, where in treating depression and schizophrenia, they would drill and destroy part of the brain they believed was responsible for this (there is evidence that people actually survived this!)1550 BC: 54911919812000Ancient Greek physician Hippocrates was the first to theorise that mental health was caused by physical entities. He believed that madness resulted in an imbalance of 4 bodily fluids and could be cured by balancing these.These include: blood, yellow bile, black bile, and phlegm. For example depression was thought to be a result of an excess of black bile and certain diets and laxatives would rebalance this excess.5369939311358001300-1400’s:Superstition returned. Mentally ill people were possessed by witches and spirits or werewolvesTreatment: exorcism or burning of the witchesEpilepsy was one of the illnesses that were frequently confused with witchcraft or demonic possession and, as these were more prevalent in women, more women were burned as witches than men. The burning of witches began to fade in the 1500’s due to a greater understanding of epilepsy.1800’s: Part 1Introduction of mental asylums – housing and confining the mentally ill.593660512073500Focused on keeping ill people away from society. Most inmates were institutionalized against their will, lived in filth and chained to walls, and were commonly exhibited to the public for a fee. Bedlam Asylum Mental illness was nonetheless as a physical illnesses and therefore treatments such as purges, bleedings, and emetics (a drug that causes vomiting) were used.right20551001880’s: Part 2Other treatments included dousing the patient in either hot or ice-cold water to shock their minds back into a normal state. 538482511459700“Gyrating chair” was intended to shake up the blood and tissues of the body to restore equilibrium, but instead resulted in rendering the patient unconscious without any recorded successes.1990’s:Mental asylums were seen as poor treatment towards the mentally insane. Psychiatry became a medical specialtyFreud attempted to explain mental illness as a result of the mind, specifically the unconscious mind, introducing ‘talking therapies’Medical model is dominant – mental health is diagnosed and treated according to the biological explanation. Medication and therapy used to treat MI.Most people able to become productive members of society but many require further careConsider how societies idea of mental health has changed throughout the years. What do you think the next 50 years will look like?Background: Defining abnormalityWhat is a normal behaviour?Conformity to the most common behaviour in societyLinked with social norms – what is deemed acceptable in that societyFor example, direct eye contact with the person you are speaking to is a social norm in the UK, but not in Sri LankaWhat is abnormal behaviour?The opposite of normalIf good mental health is thought to be normality, then poor mental health is abnormality.Rosenhan and Seligman (1984) suggested four definitions which would define abnormality. They did not say that every criteria would necessarily have to be fulfilled.Statistical InfrequencyDeviation from Social NormsFailure to Function AdequatelyDeviation from Ideal Mental Health39003021271700One: Statistical infrequencyAny behaviour that is shown less often than the normal amount for that society is, by its very nature, abnormal. 3.45% of the UK population is diagnosed with schizophrenia. 7.38% of the UK is diagnosed with depression. Both of the above statistics are statistically infrequent and therefore considered abnormal. Remember, normality = good mental health. Abnormality = poor mental health. If a behaviour is rare, it is considered abnormal. But how rare is rare? What happens if the ever-increasing diagnosis rate of mental health continues to rise and becomes statistically frequent? right25401700Two: Deviation from social normsSocial norms are a set of unwritten rules about what behaviours are expected and acceptable within a particular social group. Social norms may or may not be maintained through laws. Example 1: Checking you have locked the front door once or twice is ‘normal’, checking 24 times would be considered excessive, against social norms and abnormal (linking to Obsessive Compulsive Disorder).Example 2:Society frowns upon those who talk to themselves in the middle of the street. This deviates from social norms and therefore is considered abnormal. However, does this mean the person has a mental illness?Example 3:According to this criteria, if someone does not abide a social norm they are abnormal. What about someone who does not have a job? This goes against social norms and is abnormal, but is this an indicator of a psychological disorder?It is difficult to judge someone as abnormal if it is sometimes acceptable to break our social norms. In order to identify the extent of abnormality and the likelihood of a mental health disorder we must consider the following: The degree to which the norm is violatedThe importance of the normIs the violation rude, eccentric, abnormal or criminal?CultureTimeContextThree: Failure to function adequatelyIf a person is unable to live a normal life adequately (e.g. hold down a job, maintain a relationship, look after self, interact in society effectively) then they could under this diagnostic tool be considered abnormal. It is important to note this definition does not automatically confer the label of mental illness.Example 1:If a person does not have a job, under this criteria, they would be considered to not be functioning adequately. However, the reason the person does not have a job is important. The person may lack employment due to poor education, lack of interest, lack of opportunities, employment experience etc. Whilst they would fit this criteria, they would not be considered failing to function adequately. They would not be considered abnormal or suggest mental health struggles.Example 2:If a person spends all of their financial resources on alcohol, cannot function properly when drunk/is always drunk, and cannot take care of self, this person would fit the criteria and would be considered failing to function adequately.Four: Deviation from ideal mental healthIdeal mental health:Feeling positive about self and ability to grow psychologicallySelf disciplineAbility to act independentlyAccurate perception of reality and ability to cope with demandsPositive social interactions with friends and familyThese do not have to be present at all timesPoor mental healthSuffering – in some way a person has negative consequences of their behaviourMaladaptiveness – inability to fit in with societyUnconventional behaviour – something that wouldn’t be expected in societyIrrational behaviours which cannot be understood by othersUnpredictability/loss of controlViolation of moral standards where behaviour fails to meet standards set out by societyRosenhan said, ‘normal’ people may display some of the ‘poor mental health’ criteria. Rosenhan’s criteria is vague, difficult to measure and hard to quantify.Background: Categorising mental disorders How do we know what mental health disorders are?What are the two main diagnostic criterions used?Diagnostic and Statistical Manual of Mental Disorders (DSM). This is predominately used in the USAInternational Classification of Disorders (ICD). This is predominantly used by the rest of the world489593847548300Both introduce a logical process of assessing behavioural symptoms and characteristics for each disorder. Both aim to exclude the influence of subjective opinions to increase credibility. Each are updated every few years for example:Out with the old: In 1986, Homosexuality was removed as a psychological disorderIn with the new: Hoarding was previously regarded as a symptom or subtype of Obsessive Compulsive Disorder, but is now considered as a separate, distinct disorder. And in 2013, internet gaming disorder was introduced.Who creates the DSM?15 psychiatrists discuss what seems “most valid” in terms of symptoms, the number of symptoms and the length of prevalence of each symptom to warrant a diagnosis for every mental illness.Discussions usually last 3 hoursPsychiatrists are encouraged to use personal consensus to make decisions. It is reported that if no agreement could be met, a vote would be conducted. They fail to acknowledge that their agreement does not constitute as evidence for the mental health condition nor its characteristics. For example, my belief in God does not prove God exists. Just as their belief in a set of behaviours which make up a mental health issue, does not mean the mental health issue exists.Is the DSM scientific?A whistle-blower from within the DSM reported that another member said “We cannot include that [as a characteristic of a disorder] as I do that!”.Another whistle-blower reports a conclusion was often dependent on the opinions of those with the strongest personality or those with the loudest voice. 1. Consider what you know about authoritative figures and their influence. How might this influence the DSM?2. Can the characteristics and symptoms within the DSM be considered:Scientific?Objective?To support their aim which was to exist in the absence of subjective opinionsIn 1952, the DSM-II considered homosexuality as a psychiatric disorder. At this time Gay Rights movements accused psychiatry of lacking scientific evidence for their decision. Due to social pressures, around 8,000 psychiatrists conducted a vote on whether homosexuality should be considered a mental illness. The ‘no’ vote won by a small majority and so homosexuality was excluded and no longer considered a mental illnessWhilst this was the correct decision, what does this suggest about the DSM in terms of…The evidence used to make decisions on whether something is a mental health illness or notThe percentage of votes which matters when making a decisionThe influence of political and social pressures over their decision makingDid they meet their aim which was not to fall under subjective influences?The DSM and cultureWestern culture dominantSelf-Defeating Personality Disorder (SDPD) symptom is self-sacrifice. This is religious practice in Indian cultureHearing voices in head warrants diagnosis of schizophrenia, however in Plain Indian tribe = normative experienceEthnocentrism = cultural bias. Consider who the DSM/ICD reflects and who it ignores. Does the DSM have ethnocentrism?How reliable is the DSM?Beck et al. (1962) found that when 153 patients were assessed by two psychiatrists, only 54% of diagnosis’ were agreed. Cooper et al. (1972) found New York psychiatrists were twice as likely to diagnose schizophrenia as London psychiatrists who were twice as likely to diagnose depression when shown the same video tapeWhat does this suggest about the DSM in terms of…How correct the measurements of MH areHow reliable the measurements areStrengths of the DSM/ICDWeaknesses of the DSM/ICSHelps to establish a reliable way to categorise and diagnose behavioursHighly subjective – can change from one health professional to the nextHelps to direct the most appropriate treatment for an individuaRequires self-report from individuals who may not perceive their behaviour as abnormal or dysfunctional, or who may be prone to lying/disordered thoughts or social desirability Helps the individual come to terms with and understand why they are different. It is almost a relief to take the weight off their mind. The fear of the unknown is reduced. Now they can get help.Ethnocentrism – it depends on the culture to how behaviour is perceived, some cultures may see behaviours as the norm where others would notHard to diagnose reliably due to individual differences and biasExam questions:General guidance for comparison questions (typically 6-10 marks)One paragraph: Approx. 3 marksPoint: State point of comparison. The X explanation and the Y explanation are similar because they both are reductionist.Explain 1: Explain how X is reductionist. Explain 2: Explain how Y is reductionist.You will need between 2/3 paragraphsHistorical views of mental health Outline one historical view of mental illness (3 marks)Compare two historical views of mental illness (6 marks)Using your knowledge of the historical explanation of mental health. Explain how treatments of mental disorders have changed (6 marks)Mr. Smith has an intelligence quotient (IQ) of 66. This is in the bottom 2% of the population. Explain what may have been believed to be the cause of this behavior now compared to earlier in history (4 marks)Discuss the situational/individual explanations in relation to the historical context of mental illness. (6 marks)Diagnosing and categorising mental health issuesOutline one definition of abnormality (2 marks)Explain why labelling people as ‘abnormal’ could be considered unethical (3 marks) Discuss the issue of defining abnormality in relation to ethnocentrism. (5 marks)Key research: Rosenhan (1973) On being sane in insane placesBased on the research on the previous research (Beck, and Cooper), Rosenhan raised a pinnacle question; Can we tell the difference between the sane and the insane?“Who in the rainbow can draw the line where the violet tint ends and the orange tint begins? Distinctly we see the difference of the colours, but where exactly does the one first blendingly enter into the other? So with sanity and insanity.”“If you talk to God, you are praying; If God talks to you, you have schizophrenia.” Szasz (1973)Rosenhan’s research:Rosenhan is part of the ‘anti psychiatry movement’. He, and others, accept that mental suffering and deviant behaviours do exist. However, they question whether the most useful way of understanding such behaviour is through a rigid system of classification.Theory which led to this…Benedict (1934) normality and abnormality are not universal, but culturally specific Strong belief that an individual can present symptoms, these symptoms can be categorised, allowing the sane to be distinguishable from the insaneAims:Rosenhan wanted to look at whether psychiatrists can reliably tell the difference between those who are sane and those who are insane.To test the reliability and the validity of psychiatric diagnosisTo observe and report on the experience of being a patient within a psychiatric hospitalProcedure:Study 1:8 individuals attempted to gain entry to psychiatric hospitals across America.All eight individuals used fake names with fake occupations. No alterations of person, history and circumstances were made. These facts are important to remember. If anything, they strongly biased the subsequent results in favour of detecting sanity, since none of their histories or current behaviours were seriously pathological in any way.12 hospitals were selected across 5 states which ranged in age, resources and staff ratios. Only 8 were approached.Why is this a good thing?Each participant approached their chosen hospital individually. Each complained they had been hearing voices which said “empty”, “hollow”, and “thud” – all words which suggest darkness.All individuals were instantly admitted to hospital. All were diagnosed with schizophrenia, bar one which was diagnosed with manic-depressive psychosis.Upon admission, all individuals stopped showing any symptoms (stopped hearing voices)The staff would misinterpret their normal behaviour…Being early for lunch would be seen as “oral acquisitive syndrome”Checking the time or looking around was seen as “paranoia”This shows that normal behaviours were taken and used to fit the diagnosis. Everything a patient did was interpreted in accordance to the diagnostic label once applied. “The stickiness of labels”The individuals were never detected as being ‘under cover’. All individuals requests to be discharged were denied. They had to wait until they were “fit for discharge”. The average stay was 19 days, with the longest being 52 days. Upon release, all participants were diagnosed as schizophrenia “in remission”. The stickiness of labelsConsider what “in remission” meansStudy 2:Rosenhan’s study sent shockwaves through psychiatry – that the professionals could not detect the difference between insane and sane. One of the hospitals challenged Rosenhan to send over more ‘false patients’ over the next three months and the hospital would be able to identify them.Rosenhan agreed.After 3 months, the hospital reported 83 false patients sent by Rosenhan. These individuals were refused care.Rosenhan send zero.Rosenhan showed…In study 1, psychiatry failed to detect…. Type 1 error (TORN)In study 2, psychiatry failed to detect… Type 2 error (TTAN)Conclusions:Psychiatric diagnosis is extremely inaccurate – Rosenhan supports that we cannot distinguish sane from insaneHospitals seem to discourage help to those who need it, encourage depersonalisation and powerlessness rather than helping and supporting. Labelling is powerful – and sticks! (‘in remission’ compared to broken leg)DSM has poor reliabilityThe diagnosis can be influenced by the situationHow do the following debates link to the topic?Usefulness of researchYesReviews diagnostic criteria, raises concerns about treatment of MH patientsNature/NurtureNurture Rosenhan may support more of a nurture side due to effect of maltreatmentNatureMajority of history of MH consider it to be biological or supernaturalFreewill/DeterminismFreewillPeople in MH lack free will. The stickiness of labels outlined by Rosenhan suggest treatments of MH are determined by previous attitudes held about MHReductionism/holismReductionistDefinitions of statistical infrequency and deviation from social norms are limited and simplistic DSM can be said to be reductionist due to simple nature of listing symptomsHolismDeviation from ideal mental health is more holistic, considering how a number of factors interactIndividual/situationalIndividualMH is often described as an individual difference in psychology, the diagnosis system is there to assess the individualSituationMH can be caused by the situational factors shown in Rosenhan, and how institutions create powerlessness and depersonalisation Possible exam questions:Rosenhan (1973) hypothesised that psychiatrists cannot reliably tell the difference between people who are sane and people who are insane. With reference to the key research, discuss how the classification of mental illness could result in the ‘stickiness of labels’ (5 marks).Evaluate the validity of diagnoses of mental health disorders (5 marks)Explain what is meant by the reliability of the diagnoses of mental disorders (5 marks)With reference to the Rosenhan study, discuss the socially sensitive debate [6]General guidance: To What Extent AND Discussion questions (typically 10 marks)You must argue both sides (It is… and it is not…)One paragraph: worth approx. 3 marksPoint: Rosenhan’s research can/cannot be considered socially sensitiveDefinition: Define the socially sensitive debateExplain: Explain why it is/is not socially sensitiveChallenge/Extend: Provide counterargument as to why the explanation needs to be socially sensitive/it is positive to be socially sensitive etc.You must have two paragraphsApplication: Characteristics of an affective, psychotic and anxiety disorderYou need to know…The characteristics/symptoms of each disorderIssues with diagnosing the disorderYou will need to know this for at least one affective disorder, one psychotic disorder and one anxiety disorderThree categories of disorders:Affective disorders are mood disorders, such as depression or maniaPsychotic disorders are disorders where the patient loses touch with reality, such as schizophrenia and bipolarAnxiety disorders include phobias, obsessive compulsive disorder and post-traumatic stress disorderClassification of Schizophrenia5104765889000Schizophrenia is a severe mental disorder characterised by profound disruption of cognition and emotion. Schizophrenia is a psychotic disorder. It is a severe mental disorder in which thoughts and emotions are so impaired that contact is lost with external reality. Schizophrenia is the most common psychotic disorder, affecting about 1% of the population. Schizophrenia is most often diagnosed between the ages of 15 and 35, with men and women affected equally. Diagnosing Schizophrenia There are many symptoms of the disorder, although not every patient displays all the symptoms. The most recent update of ICD is ICD-10, with ICD-11 (published in 2017). The symptoms are divided into positive and negative symptoms. Two or more of the symptoms must be experienced for one month in order to be diagnosed as schizophrenic.Positive SymptomsPositive symptoms are those that appear to reflect an excess or distortion of normal functions. They include the following:49575685823900Hallucinations – bizarre, unreal perceptions of the environment that are usually auditory (hearing voices) but may also be visual (seeing lights, objects or faces that others can’t see), olfactory (smelling things that others can’t), or tactile (e.g. feeling that bugs are crawling under the skin or something touching the skin). Many schizophrenics report hearing a voice or several voices, telling them to do something (such as harm themselves or someone else) or commenting on their behaviour. Delusions – bizarre beliefs that seem real to the person with schizophrenia, but they aren’t real. Sometimes these delusions can be paranoid (i.e. persecutory in nature). This often involves a belief that the person is being followed or spied upon by someone else. They may believe that their phone is tapped or there are video cameras hidden in their home. Delusions may also involve inflated beliefs about the person’s power and importance (delusions of grandeur). E.g. the person may believe that they are famous or have special powers or abilities. Disorganised speech – is the result of abnormal thought processes, where the individual has problems organising his or her own thoughts and this shows up in their speech. They may slip from one topic to another (derailment), even in mid-sentence, and in extreme cases their speech may be so incoherent that it sounds like complete gibberish – something that is often referred to as ‘word salad.’56566871760700Disorganised behaviour – includes the inability or motivation to initiate a task, or to complete it once it’s started which leads to difficulties in daily living and can result in decreased interest in personal hygiene. The individual may dress or act in ways that appear bizarre to other people, such as wearing heavy clothes on a hot summer’s day. Catatonic behaviours are characterised by a reduced reaction to the immediate environment, rigid postures or aimless motor activity. Negative SymptomsThese symptoms are those that appear to reflect a reduction or loss of normal functions, which often persist even during periods of low (or absent) positive symptoms.Negative symptoms include:Socially withdrawn– A reduction in the interest and desire, as well as the inability to imitate and persist in goal-directed behaviour. This is an extreme version of poor social function, as the individual has low self-initiated involvement in activities which are available to patient 5348670659700Affective flattening - a reduction in the range and intensity of emotional expression, voice tone, eye contact and body language. Compared to controls without this symptom, individuals show fewer body and facial movements and smiles, and less co-verbal behaviour (i.e. those movements of the hands, head and face that usually accompany speech). When speaking, patients may also show a deficit in prosody (i.e. paralinguistic features such as intonation, tempo, loudness and pausing) that provide extra information that is not explicitly contained in a sentence, and which gives cues to the listener as to emotional or attitudinal content and turn-taking. Suicidal – Individual experiences negative thoughts and contemplates taking one’s life.Classification of Depression4931410102267200Depression is an affective disorder. It affects how you feel, think and how you act. Depression is more than feeling unhappy or fed up for a few days. Depression is a common and serious mental illness. Approximately, 1 in 4 people in the United Kingdom will be diagnosed with depression each year.Diagnosing Depression There are many symptoms of the disorder, although not every patient displays all the symptoms. The most recent update of ICD is ICD-10, with ICD-11 (published in 2017). Five or more of the symptoms must be present during the same two-week period. Symptoms in italics are required for a diagnosis of depression. The symptoms should not be related to any other cause such as another disorder or the use of substance(s). The symptoms must cause significant distress or impairment on functioning.SymptomsPsychological symptoms4719222557036700Depressed mood. Extreme sadness. This also includes the individual crying. The individual is likely to not have a known reason for this.Recurrent thoughts of death. The individual will regularly think of death. Often contemplating their own death. The individual may or may not consider self-harm.Excessive feelings of self-worth. Typically, individuals will perceive themselves as worthless.Physical symptomsAppetite. Individuals who suffer depression often loose their appetite. However some, gain an appetite. The change in ones eating patterns can influence the following physical symptoms.Diminished concentration and loss of energy. The individual will report feeling exhausted, even after a full 12 hours of sleep. The individual will also struggle to pay attention, even to things they enjoy! Both of these may or may not link to the following symptom.right77135200Insomnia or excessive sleep. Changes in individuals sleeping patterns may occur. Individuals may struggle to get to sleep (at all!). If this occurs, this will explain their diminished concentration and loss of energy. In other instances, individuals may sleep an excessive amount. Here, individuals can still report feeling tired. Social symptomsNoticeably reduced interest or pleasure in activities. Individuals will not want to partake in the activities they once enjoyed. Again, this can be lined to their lack of energy, depressed mood and thoughts of self. General restlessness. Individuals are easily irritated over things which may not usually irritate them. Classification of Phobiasright132969000A phobia is an anxiety disorder. It is an overwhelming and debilitating fear of an object, place, animal or feeling. It produces a conscious avoidance of the feared ‘thing’. If a phobia becomes very severe, a person may organise their life around avoiding the thing that's causing them anxiety. As well as restricting their day-to-day life, it can also cause a lot of distress. Phobias affect around 2% of the UK population. There are many different types of phobias. Ranging from arachnophobia – the fear of spiders, to claustrophobia – the fear of confined spaces.Diagnosing a Phobia There are many symptoms of the disorder, although not every patient displays all the symptoms. The most recent update of ICD is ICD-10, with ICD-11 (published in 2017). The diagnosis of a phobia depends on each phobia itself. The diagnosis of agoraphobiaThe diagnosis of agoraphobia is the fear of social situations. Individuals who have agoraphobia experience fear and avoidance in places or situations that may cause you to panic and make you feel trapped, helpless or embarrassed.SymptomsIndividuals must experience some of the followingSweating334264011224The symptoms must persist for six months of more. The individual must experience a persistent fear and attempt to avoid the phobic situation. this is likely to occur to the extent which it disrupts normal life. And the individual suffering must recognise their excessive fear. 00The symptoms must persist for six months of more. The individual must experience a persistent fear and attempt to avoid the phobic situation. this is likely to occur to the extent which it disrupts normal life. And the individual suffering must recognise their excessive fear. TremblingShortness of breathRapid heartbeatNauseaFeeling faintDry mouthNumbnessFeelings of dread3783190828298100Feelings of dyingIndividuals must experience some of these symptoms in two or more of these situations:Using public transportBeing in open spacesBeing in enclosed spacesStanding in line or in a crowdBeing outside of home aloneActivity: Read the scenarios on the left. Identify which disorder the patient is suffering from. You must highlight key terms which justify your explanationScenario 1:Martin is a 21-year-old business student. Over the last few weeks, his family and friends have noticed increasingly bizarre behaviours. On many occasions, he has been overheard whispering in an agitated voice, even though no one is near. Lately, he refuses to answer or make calls on his iPhone, claiming that if he does it will activate a deadly chip in his brain that was implanted by aliens. Yesterday, he refused to attend university. Instead, he conspired with the aliens to have himself killed so that they can remove the chip (and his brain) and replace it with one of theirs. What would you diagnose Martin with? And why?Scenario 2:Jessica is a 28-year-old married woman. She is a medical resident at a hospital in a large state in the US. She has very high standards for herself and can be extremely critical when she does not reach them. Lately, she has been struggling and does not think she is good enough to be on the course. She often shames herself due to her inability to perform as well as she has in the past. In the past few weeks, her co-workers report her as irritable and withdrawn, which is different from the upbeat, friendly Jessica they know. As she has felt ‘under the weather’, she has called in sick a number of times. These days are spent sleeping. She does not even wake up or get out of bed for a meal!What would you diagnose Jessica with? And why?Scenario 3:Despite being a 52-year-old married man, Jim has never made an appointment in his life. If he requires a doctor’s appointment, his wife Lesley will arrange it for him. Lesley arranges everything for him. Whether it be phoning for a take away to arranging social events; that’s Lesley’s ‘job’. This issue doesn’t just occur when it comes to phone calls, he is very shy even when he sees them in person. Many of the couple’s friends think Jim is lazy and has no interest in maintaining their friendship. But really, Jim is afraid he will say the wrong thing and they will laugh at him. And so, he would rather be quiet or miss out on events to avoid any shame.What would you diagnose Jim with? And why?Exam questions:Describe the characteristics of a psychotic disorder [5 marks]Describe the characteristics of an anxiety disorder [5 marks]Describe the characteristics of an affective disorder [5 marks]Leana is a clinical psychologist. She believes that her patient is experiencing a psychotic/anxiety/affective disorder. Assess one difficulty that Leana could experience trying to confirm that her patient is indeed suffering a psychotic/anxiety/affective disorder [6 marks]Component 2: Medical Model (as an explanation for mental illness)Medical model assumesAll mental illnesses are similar to physical illnesses Any mental illness will have a physical cause and should be treated accordinglyOrigin typically is biologicallyBackground: Biochemical explanationright2438582Biochemical explanations For us to think, feel or make decisions, our brain cells must transmit information in the form of electrical impulses around the brain. Each brain cell transmits information to the next through a synapse. Chemicals called neurotransmitters must pass through synapse for information to pass. One explanation for mental illness involves the possibility that symptoms are as a result of abnormal neurotransmitter levels.Biochemical explanations for…DepressionA group of neurotransmitters called the monoamines appear to be involved in depression. These monoamines include; serotonin, noradrenaline and dopamine. Research suggests dopamine is responsible for mood. Serotonin is thought to control the activity of dopamine and noradrenaline. And so, if serotonin levels are low this means the dopamine is not regulated and can have a negative effect on mood.One version of monoamine hypothesis of depression says that reductions in serotonin levels which typically follow stressful events leads to failure to regulate dopamine and noradrenaline function normally. This leads to disrupted moods and activity levelsSchizophreniaHigh levels of dopamine in certain areas of the brain responsible for speech production may cause symptoms of schizophrenia e.g. hallucinations of voices. More recently, a new take on the dopamine hypothesis has focused instead on reduced dopamine levels or activity in the brains cortex (Goldman-Rakic et al. 2004). Thus, low levels or activity of dopamine in the prefrontal cortex which is responsible for thinking and decision-making may explain other symptoms of schizophrenia, including apathy and incoherent thought or speech.However… Did the imbalance cause the mental health issue or did the mental health issue cause the imbalance?Background: Brain abnormality explanationright259800Brain abnormality It is thought that the structure of one’s brain and its function is linked to mental illness. For example, certain structures in the brain may develop with a different size or shape and levels of electrical activity can be higher or lower in particular areas of the brainBrain abnormality as an explanation for…DepressionEvidence exists which suggest depression occurs as a result of brain abnormality. Some studies suggest the importance of the frontal lobe – the region of the brain, which is involved with thinking.Coffey (1993) compared the size of depressed patients and non-depressed patients using an MRI scanner. He found the mean frontal lobe volume in depressed patients was significantly smallerSchizophreniaThere is also evidence, which suggest that schizophrenia occurs due to the left hemisphere of the brain not functioning normally.Purdon (2001) compared the force of the right and left hand in 21 patients with schizophrenia and a control group. Ten in the treatment group were given antipsychotic medication and tested again. Compared to the treated group, the untreated group were significantly weaker in right hand, not left. Why would a weakness in the right hand mean their left hemisphere isn’t functioning correctly??There is also evidence to suggest that negative symptoms of schizophrenia, such as loss of motivation, are associated with brain abnormalities. Motivation (in particular the anticipation of a reward) is believed to involve a brain region called ventral striatum in schizophrenia. Jucket 2006 found lower levels of activity in VS amongst schizophrenics than controls. Jucket found negative correlation between these variables (lower the activity levels fall, the higher the occurrence of negative symptoms).Hallucinations are also associated with abnormal brain function. Allen et al. 2007 scanned brains of those experiencing auditory hallucinations. He compared these to a control group. Lower activation levels found in two brain regions – superior temporal gyrus and anterior cingulate gyrus – were found in hallucination group (than control). It can be concluded abnormal function in these areas is associated with hallucinations in schizophrenia Background: Genetic explanationGenetic explanationright1206500As humans, we randomly inherit half of our genetic material from mother and other half from father. Our total genetic makeup of individual is known as genotype. It is unlikely any mental illness is purely result of genetic factors; however, it does appear that some people are more vulnerable than others to developing mental health issues as a result of genetic makeup.Genetic explanation for…DepressionThe strongest predictor of depression is the experience of stressful life events. However, we do not all respond to the same stressor in the same way. More recent research looks at the influence of particular genes and how those genes interact with the environment, together influencing symptoms.Researchers are interested in looking at the serotonin transporter gene. This is responsible for producing serotonin in the brain. The gene comes in three forms, varying in length of strands; Long-long, long-short, short-short. Short short is believed to lead to inefficient serotonin production. This means those with SS are less resilient than others to stress and more vulnerable to depression.SchizophreniaSchizophrenia runs in families. However this does not necessarily mean it is genetic in origin, Families share genetics and environment! There is a strong relationship between genetic similarity and risk of developing schizophrenia (see figure 1.13, on page 27). Exam questions:Outline one biological explanation of mental disorders (5 marks)Structure:State and explain biological explanation (3 marks)Link biological explanation to a specific disorder (2 marks)You should write three answers – one for each explanation.Key research: Gottesman (2010) Disorders in offspring with two psychiatrically ill parentsBackground:Previous research has found that if one parent has a mental disorder there is an increased likelihood of the child also having a mental disorder.Gottesman’s (2010) study wanted to investigate if two parents having a mental disorder would further the risk of their child also having a disorder534543017335500Aim:Examine how vulnerable children of two parents with mental illnesses are in terms of developing a mental illness themselvesSpecifically, the researchers were interested in vulnerability to any mental disorder of children of parents suffering schizophrenia and/or bipolar disorderMethod: Records from the population of Denmark were gathered using the Civil Registration System. No consent was needed as the data gathered was from public domain and names were anonymous.Sample:Drawn from population of 2.7 million Danish people born before 1997 who had identifiable mother and fatherData was sampled in 2007, so minimum age of ppt was 10 years oldFrom this population (of 2.7 million), a sample of 196 couples were selected who had a diagnosis of schizophrenia (and the 270 kids associated)Additionally, 83 couples with diagnosis' of bipolar disorder (and 146 kids)In the sample chosen, both parents were considered to have mental illnessFor comparison, samples were only one parent had diagnosis of either schizophrenia or bipolar were drawnRates of mental disorder drawn from remainder of population where neither parent had schizophrenia or bipolar disorderDesign and procedure:Cohort study as it involves looking at cohort of a population. i.e. the population born between two datesNatural experiment (comparing two naturally occurring groups)IV = parents schizophrenia or bipolar disorderDV = diagnosis of mental illnessResults:For schizophrenia and bipolar disorder the risk of mental illness was much greater for offspring of two parents with a diagnosis Figures for schizophrenia:27.3% of offspring with both parents having a diagnosis of schizophrenia had developed schizophrenia by age 5267.5% developed mental illness of some sortThose with one parent suffering;7% diagnoses with schizophrenia1 1% diagnosed with any mental illnessFor those without any parent suffering = 1 .12% for schizophrenia, 14.1% for any disorder Figures for bipolar:24.95% of offspring of two bipolar parents developing the disorder by ace of 5236% developing either bipolar or depression44.2% a mental illness of some sortThose with one bipolar parent4.4% developed bipolar themselves and 9.2% for any MHDConclusionHaving both parents with serious mental illness is associated with significantly increased risk of developing not only that mental illness but mental illnesses in generalHaving one parent with serious mental illness caries lower riskThis provides useful info for genetic counselling which involves advising people of their own risks of developing illness or passing on genetic vulnerability to their childrenExam question: Explain what the key research by Gottesman et al. (2010) tells us about mental disorders (5 marks) 3 marks - show understanding of the Gottesman study (Details of study)2 marks - clearly explain what this tells us about mental illnesses (State finding and explain what that tells us about prevalence of mental illness — do this for Schizophrenia and then again for Bipolar).Application: Biological treatment of one specific disorderBiological treatments for mental illnesses51595657770900Treatment 1: AntidepressantsOne common treatment for someone who is experiencing depression is antidepressant drugs. There are a number of different antidepressant drugs and each drug work in slightly different ways. Generally, antidepressants work by raising the levels of monoamine neurotransmitters in the brain.What are antidepressants and how do they work?Nonoamine oxidase inhibitors (MAOIs) prevent the breakdown of serotonin, noradrenaline and dopamine. This means that the levels of all three monoamines build up. One type of antidepressant Tricyclics prevent serotonin and noradrenaline being absorbed after they have crossed a synapse (again increasing their levels). These are effective at reducing the symptoms of depression, however they interfere with a number of neurotransmitters and have serious side effects for example drowsiness, dry mouth and constipation.6638990565762660049688491857056594415786769590524170060Newer antidepressants work on one monoamine only (compared to MAOI which worked on all three). These are as follows:Selective serotonin reuptake inhibitors (SSRIs) such as Prozac and Seroxat stop serotonin being reabsorbed and broken down after it has crossed the synapse.Noradrenaline uptake inhibitors (NRIs) do the same with noradrenaline.The prescription of antidepressantsIt is important to have a number of anti-depressants available because individual patients may vary in how they respond to each drug - in terms of their symptoms and the side effects. Different people present different symptoms and this can influence the choice of drug. NRIs for example may be particularly useful for motivating patients whose depression has left them inactive. Similarly, Gender influences the prescription. Women suffer more side effects than men from tricyclic antidepressants so the latter is more appropriate (and prescribed more) to men.Ethical issue: It is widely believed that antipsychotic drugs have been used in hospitals to make patients calmer and easier for the staff to work with, rather than being used to benefit the patients. This practice is seen by some as human rights abuse.Ethical issue: There are a range of side effects which come from the use of antipsychotic drugs. Older antipsychotics such as Chlorpromazine are associated with dizziness, agitation, sleepiness, weight gain and itchy skin. Long term use can result in damage to the central nervous system which manifests as involuntary facial movements (this is called tardive dyskineasia).Treatment 2: Electroconvulsive therapy (ECT)One way to treat depression is through ECT. The procedure involves administering an electric shock for a fraction of a second to the head, inducing a seizure similar to epilepsy. In most incidences, the shocks are bilateral (given to both sides of the head). This is considered more effective than unilateral (given to only one side of the head). The seizure lasts between 15 and 60 seconds. A typical course of treatment might run for two to three weeks. with the ECT being repeated between six and twelve times.According to the NHS there were 7,000 treatments in England and Scotland in 2011, compared with 12,800 between January-March 2002 and 16,500 for the same quarter in 199983520818015396852365294464861268930513384724723648803Ethical issue: ECT is controversial. In its early use the shock was relatively large and given without anaesthetics or muscle relaxers. This' resulted in broken bones and burns to the brain.Modern ECT involves:Small shocks for short periods (typically 800 milliamps for a fraction of a second)Given under anaesthetic and using drugs to paralyse muscles to prevent injury (e.g. broken bones)730093281725How does the topic link to debates?NATURE VS NURTUREMedical model supports the nature side, as does all biological explanations for mental illness. Large emphasis on genetic vulnerability ignores environmental factors. However, it does look at environmental factors which are linked with biology (oxygen starvation during childbirth, prenatal exposure to flu, and childhood head injuries – all of which have been linked to mental health).FREEWILL VS DETERMINISMThe medical model is very deterministic. Symptoms are seen as determined by brain or biochemical abnormality, which are in turn determined by genetic vulnerability. Very little room for freewill – this is a limitation of the approach.REDUCTIONISM VS HOLISMThe medical model is seen as reductionist – the mind being reduced to the brain, human experience is reduced to biological events. It ignores that we are more than a sum of brain cells and chemicals. However it is not possible to study the whole human nature at the same time, so it can be argued the approach needs to be reductionist. INDIVIDUAL VS SITUATIONALBiological explanations are thought to support the individual side of the debate – with emphasis on the role of genetics, brain chemistry and abnormal brain structure and function. Specifically, focusing on why some individuals experience mental illness and others do not.However, mental illness is not just influenced by individual differences. It is associated with a range of situational variables such as stress and poverty etc. These have not been taken into account.USEFULLNESS OF RESEARCHResearch into mental illness is very useful. It introduces a range of treatments and allows us to see how effective already existing treatments are. Arroll (2005) compared antidepressants with placebo. He found 56-60% of participants treated with depressants improved, compared to 42-47% given the placebo.PSYCHOLOGY AS A SCIENCEBiological explanations for mental illness are considered to be scientific. The approach (and explanations) are based firmly on research. Scientific techniques are used to study biological explanations for example, the scanning techniques used to study brain abnormality and the genetic sequences used to find associations between genes and mental illness. The biological treatments have also been tested scientifically.Exam questionsTo what extent are explanations of mental illness reductionist? (10 marks)Discuss the nature/nurture debate in relation to the biological explanation of mental illness (10 marks)Discuss the usefulness of research in relation to the biological explanation of mental illness (10 marks)General guidance: To What Extent AND Discussion questions (typically 10 marks)You must argue both sides (It is… and it is not…)One paragraph: worth approx. 3 marksPoint: Explanation of mental health can/cannot be considered reductionistEvidence/Example: introduce and explain one (of three) explanationsExplain: Explain why it is/is not reductionistChallenge/Extend: Provide counterargument as to why the explanation needs to be reductionist/it is positive to be reductionist etc.You must have three paragraphsSuggest how biological treatments can be used to treat one specific disorder. (5 marks)Outline how the biological approach would explain one of the following disorders; affective; anxiety; psychotic (5 marks)Outline evidence suggesting that genetic abnormality causes any one mental disorder [6]Compare the biochemical explanation of mental illness with brain abnormality as an explanation of mental illness. [10 marks]General guidance for comparison questions (typically 6-10 marks)One paragraph: Approx. 3 marksPoint: State point of comparison. The X explanation and the Y explanation are similar because they both are reductionist.Explain 1: Explain how X is reductionist. Explain 2: Explain how Y is reductionist.You will need between 2+3 paragraphsComponent 3: Alternatives to the Medical ModelChecklist…Three alternative explanation (s)The associated treatment(s) How each treatment links to debatesYou need to know the behavioural and the cognitive explanations for mental illness. You also need to learn one other explanation from the following options:? Humanistic ? Psychodynamic Behaviourist explanation of mental illness *compulsory*Contrasting with the medical model, the behaviourist explanation considers the processes of learning to explain the origin of mental disorders. In other words, abnormal behaviour is assumed to be learned in the same way other types of behaviours are learned. This can occur through different types of learning (classical conditioning or operant conditioning).3030220371094000Classical conditioningClassical conditioning happens due to association. This is where an emotional response, such as fear or anxiety, becomes associated with a neutral stimulus. Classical conditioning was famously demonstrated by Pavlov (1903). He noted dogs salivated when presented with food. He presented dogs with food while simultaneously ringing a bell. This taught the dogs to associate food with the ringing of the bell. Pavlov done this so many times that the dogs would salivate when the bell was rang in the absence of food. If a person is regularly exposed to a stimulus which is paired with an unpleasant experience, the stimulus will come to elicit a negative response in the person. One example of this is the case study of Little Albert by Watson and Rayner (1920). Little Albert was a healthy, normal 11-month-old infant. The researchers would present a white rat to the infant while simultaneously striking a hammer against a metal bar. This would cause a loud noise, causing Little Albert to cry. This was done numerous times resulting in Little Albert crying when presented with the white rat, in the absence of the noise. This showed how phobias can be learned through classical conditioning.Both examples show how behaviours can be learned through association (classical conditioning). While the phobia Little Albert developed was deliberately induced, the process could be applied to real-life situations. For example, people may develop hydrophobia (fear of water or drowning) as a result of falling into water as a young child. Their inability to swim and being submerged may have allowed the person to develop a powerful lifelong fear of water. Another example: Someone going to work everyday and feeling really down, may associate work with depressive moods. They then might avoid going to work and become further isolated – leading to further depressionOperant conditioningOperant conditioning explains how the consequences of a behaviour shapes the continuation or discontinuation of the behaviour. For example, if a positive consequence/reinforcement follows a behaviour (money, food or any other reward) the behaviour is likely to be repeated. However, if a negative consequence follows the behaviour (the removal of something good) the behaviour is less likely to be repeated.right194140900This process can easily be observed through addictive behaviours such as addiction to drugs, alcohol or gambling. If someone tries gambling and has success, the behaviour of gambling is reinforced. What starts as voluntary can become ‘addictive’. The player experiences a compulsive need to keep playing. One reason gambling is particularly addictive is that it creates an intermittent schedule of reinforcement. A continuous schedule of reinforcement would be when each time the correct behaviour is displayed, the individual is reinforced. Whereas, variable schedules of reinforcement don’t reinforce every behaviour. Instead, they do so in variables (e.g. every third behaviour). These ratio schedules are used by slot machines in pubs and casinos. This has a strong behavioural effect, than continuous positive rewards, because often the gambler will loose but still ‘hangs in there’ hoping their luck will change.Cognitive explanation of mental illness *compulsory*Cognitive psychologists criticise the behaviourist explanation as it assumes people cannot reflect on their own behaviour nor can they control it. 4195140584400300The cognitive explanations are concerned with processes of thinking, attention and perception that underlie abnormal behaviour. The cognitive explanation relies on the idea that the cognition of a person with a mental illness are faulty; it is the way the person perceives and thinks about the situation that causes difficulty, rather than the situation itself. An individual with this irrational thinking (or cognitive distortion) will form an inaccurate perception of the reality that may be highly negatively or disturbed. These will warp their emotions and thought processes. NOTE: There is nothing deliberate or controlled about cognitive distortion. It occurs automatically.Beck (1976) recognised that adverse events happen in everyone’s life. However, for those with thought distortions, these events can lead to negative emotional and behavioural outcomes such as anxiety and depression. Beck suggests these maladaptive thinking patterns originate through ‘schema development’. Depression, for example, involves a triad of negative schemas. An individual may have early experiences of dysfunctional beliefs which may be triggered by, for example; the loss of a job. This activates the underlying thoughts about oneself, that they are worthless and inadequate. This allows the person to process any incoming information with such a negative bias. For example, they believe they will never be good at anything, and they think everyone will be against them as they are worthless. This results in all the emotional, cognitive and behavioural symptoms of depression. Burns (1989)?believed that in some individuals, specific cognitive distortions lead to depression. See belowOver-generalisation:?Viewing one unfortunate event as part of a never ending defeat or struggle e.g. ‘everything always goes wrong for me’Filtering:?Giving greater consideration and focus to negative aspects, while ignoring positive ones e.g. ‘it doesn’t matter that I passed the test because I got that silly question wrong and I’ve let myself down’Catastrophising:?Making a mountain out of a mole hill – feeling that a situation is or will be far worse than it actually is e.g. ‘I got the customers order wrong, I’m bound to get fired now’center13648TREATMENT: Cognitive-behavioural therapy (CBT) 00TREATMENT: Cognitive-behavioural therapy (CBT) Choose one other explanation from the following options to learn:? Humanistic ? Psychodynamic Humanistic explanation of mental illness *option 1*Humanistic psychology rejects both psychiatric diagnosis and complex theories such as those favoured by psychodynamic and cognitive therapies. Instead, humanistic psychology relies on many basic assumptions about human nature. These include the idea that people are good and tend to grow as individuals and fulfil their potential. Based on this, psychological problems result when external forces prevent us from achieving this growth. Carl Rogers – one of the most influential humanistic psychologists – proposed that healthy psychological development depends on two ideas: the actualising tendency and the self-concept4102735365760000The Actualising TendencyAccording to Rogers (1959), humans are motivated by the need to actualise. i.e. to fulfil their potential and achieve the best level of ‘human beingness’ they can. The relationship between the environment and the ability to actualise can be understood using the analogy of a flower. Just as a flower is constrained by the availability of environmental variables such as light, water and nutrients, people flourish and reach full potential only if environment is good enough. An unconscious process of valuing guides us towards choosing behaviours that will help us to fulfil out fullest potential. This valuing process can, however, be prevented from operating using strict social rules and by poor self-concept. The Self-ConceptRogers (1961) proposed that a particularly critical aspect of the self-concept was our self-esteem. In this theory, Self-esteem means how much we like ourselves – not our confidence levels. Rogers believed we hold in our mind an imagine of ourselves as we currently are and one of our ideal self. If these two images are congruent (the same), we will experience a good level of self-esteem.The development of congruence and the resulting healthy self-esteem depends on our receiving of unconditional positive regard from others in the form of acceptance, love and affection. Without this, we cannot self-actualise. Some children lack unconditional positive regard from their families in childhood. Hard, inattentive parenting or parenting which involves conditional love (where the child will receive love if it conforms to certain conditions) is likely to lead to low self-esteem in adulthood, and such individuals are vulnerable to mental disorders. Especially depression.62345557950TREATMENT: Humanistic therapy for depression 00TREATMENT: Humanistic therapy for depression Psychodynamic explanation of mental illness *option 2*The psychodynamic explanation emphasises on the following and their influence on one’s mental health:The influence of the unconscious mind on symptomsthe influence of early traumathe quality of early relationships The psychodynamic approach is derived clinically (based on what patients have told therapists), unlike the behaviourist and cognitive approach which are based on scientific research. The psychodynamic approach dates back to work of Sigmund Freud. Freud’s idea of The Hydraulic Model comes from the phrases ‘to cry oneself out’ or ‘to blow off stream’. Freud believes we have psychic (mental) energy which can be discharged or transformed, but not destroyed. The inability to express oneself results in a build-up of psychic energy that can lead to the symptoms of mental disorders. One of the aims of the psychodynamic therapy is to release such energy to alleviate the symptoms of mental illness.Freud’s theory of depressionFreud (1971) proposed that some cases of depression are linked with the childhood loss of a parent or rejection by parent. Here, Freud draws a parallel between the feelings we have mourning the loss of a loved one in our childhood and the experience of depression years after. Here, Freud proposes during childhood, the person would experience anger at being ‘abandoned’ through separation or rejection. As this anger cannot be expressed due to the love of the person, it is instead turned inwards. This causes guilt and low self-esteem as the ego rages against itself. This emphasises the link between early childhood trauma and the development of mental disorders.A Psychodynamic explanation for schizophreniaSchizophrenia involves hallucinations (usually voices speaking critically to or about the patient) and delusions (irrational beliefs which may include the sufferer being persecuted). Here Fromm-Reichmanm (1948) creates a link between childhood experiences and the development of mental health. She coined the term ‘schizophrenogenic mother’. She claims families characterised by high emotional tension and secrecy, where the mother is cold and domineering in her attitude allow children to have a higher risk of developing schizophrenia. This emphasises the link between the quality of relationships in childhood and the development of mental disorders.682831278287TREATMENT: Psychodynamic therapy for depression 00TREATMENT: Psychodynamic therapy for depression Key research: Ssasz (2011) The Myth of Mental Illness“Who in the rainbow can draw the line where the violet tint ends and the orange tint begins? Distinctly we see the difference of the colours, but where exactly does the one first blendingly enter into the other? So with sanity and insanity.”“If you talk to God, you are praying; If God talks to you, you have schizophrenia.” Szasz (1973)5369442373566000Psychiatry attempts to diagnose and treat mental health conditions. There still exists disputes over what can be considered normal (and thus abnormal). This can lead to the danger of diagnosing something as abnormal, when it is in fact normal. If this was to happen this would lead to the medicalisation of normal experiences. Thomas Szasz?is central to what is known as the anti-psychiatry movement. He, and others, suggest that psychiatry is a form of dangerous social control. He believes that psychiatry has a sinister agenda to control people through stigmatisation. Szasz states “Labelling a child as mentally ill is stigmatization, not diagnosis. Giving a child a psychiatric drug is poisoning, not treatment”. The review we will look at will discuss if this has changed throughout history. Szasz (2011) The Myth of Mental Illness: 50 Years LaterThomas Szasz published an essay ‘The myth of mental illness’ in 1960. In 2011 he published an article titled the same. This article is an update on his views. Szasz has the following key points:ONE: Fifty years of change in US mental healthcareThen: In the 1950’s, when I wrote ‘The Myth of Mental Illness’, most ‘mental patients’ were considered incurable and were confined in state mental hospitals. The physicians who cared for them were employees of the state government. Non-psychiatric physicians in the private sector treated voluntary patients and were paid for by the client or their family. Now: Since that time, the distinctions between medical hospitals and mental hospitals, voluntary and involuntary patients, private and public psychiatry have blurred into non-existence. All mental healthcare is now the responsibility of the government and is regulated and paid for by the public moneys. Few psychiatrists make a living from expenses from patients, and none are free to contract with the patients themselves about the terms of their relationship. Everyone defined as a mental health professional is now legally responsible for preventing the patient from being ‘dangerous to himself or others’. TWO: Mental illness – a medical or legal concept?3940810142287300Then: The question “What is mental illness?” was of interest to the physicians, philosophers, sociologists as well as the general public. This is no longer the case. The question has been settled by the holders of political power. Bill Clinton declared “Mental illness can be accurately diagnosed, successfully treated, just like a physical illness”. Surgeon David Satcher agrees “Just as things go wrong with the heart and kidneys and liver, so things go wrong with the brain”.Has political power and professional self-interest united and turned a false belief into a ‘lying fact’? The claim that mental illnesses are diagnosable disorders of the brain are not based on scientific research; it is an error, a deception. My claim that mental illnesses are fictitious illnesses are not based on scientific research either. Instead, it rests on pathologist’s materialistic-scientific definition of illness as the structural alteration of cells, tissues and organs. If we accept this definition of disease, then it follows that mental illness is a metaphor – asserting that view is stating an analytical truth. Now: Since the publication, my views have offended many psychiatrists. I intended to call public attention to the linguistic pretensions of psychiatry. I insisted that mental hospitals were prisons, not hospitals. That involuntary mental hospitalisation is a type of imprisonment, not medical care. That coercive psychiatrist’s function as judges and jailers, not physicians and healers. I suggest that we interpret mental illness and psychiatric responses to them as a matter of morals and laws – not a matter of medicine, treatment or science. In short, psychiatry is thoroughly medicalised and politicised. The opinion of the American Psychiatric Association is exemplified by the DSM and ICD. Key point: Mental hospitals are more like prisons to control peoples’ behaviour.Key point: Economic issues – big business in pharmaceuticals and treatments to treat mentally ill.Key point: Government decides what illnesses exist, control all regulation and funding.THREE: ‘Mental illness’ is a metaphorThen: The proposition that mental illness is not a medical problem runs counter to the public opinion. It is believed that soon psychiatrists will be able to show that all mental illnesses are bodily diseases. This will never happen. Now: If all, so called, mental illnesses were classified and treated as brain diseases (as thought previously) there would be no notion of ‘mental illness’ and the term would become void. However, because the term refers to judgements about the persons behaviour, the opposite happens. The history of psychiatry is an ever expanding list of mental disorders.Key point: Mental illness is a myth, not a disease that can be scientifically proven.FOUR: Changing perspectives on human life (and illness)49993701247800Then: The ‘Myth of Mental Illness’ is a new discovery. We have replaced the old, religious perspective on human nature with a more modern, dehumanised, pseudo-medical one. The medicalisation of the soul and personal suffering is intrinsic to life, and it began in the late 16th Century. Specifically, with Shakespeare’s Macbeth where Lady Macbeth ‘goes mad’. Now: Today, the role of the physician as a curer of the soul is uncontested (not disputed). There are no bad people in the world, there are only mentally ill people. Hence the ‘insanity defence’. With reference to Shakespeare, Lady Macbeth who was originally a good person becomes a ‘fallen being’ because she is mentally ill. More generally, people are inherently good unless their mental illness makes them sick or ill-behaved. In summary, the diagnosis of a mental illness can change our perspectives on human life.Key point: Medical model is now the only way of dealing with people who behave differently.Key point: People are being deprived of the freedom to behave in the way they choose on the grounds of having a disease. This also has implications for ‘insanity’ as a defence.FIVE: Mental illness is in the eye of the beholder Then: The behaviours which we call ‘mental illnesses’ and our attachment of derogatory labels to this madness are not medical diseases. Most individuals categorised as mentally ill are not sick. Depriving them of liberty and responsibility on the grounds of disease (literal or metaphorical) is a grave violation of their basic human right. Mental illnesses is a myth and it is foolish to look for the causes and cures of a fictitious ailments. They cannot be treated or cured by drugs or other medical interventions. Instead, they would benefit by respect and help to overcome the obstacles they face. Now: Having a disease is not the same as occupying the patient role: not all sick persons are patients, and not all patients are sick. Nevertheless, even now, physicians, politicians, the press and the public combine and confuse the two. Key point: Mentally ill people are actively trying to cope in the world using whatever coping mechanisms they can. They are not passive players to biological forces.SIX: Revisiting The Myth of Mental IllnessThen: Psychiatrists and their patients are moral agents. Psychiatrists deprive people of their autonomy and would be seen as a consciously imprisoning agent, not a doctor providing “treatment”. This protects psychiatrists from the moral responsibility of their actions. Now: Still, the idea of psychiatrists being ‘moral agents’ is protected and supported by the medical model. This allows psychiatry to become a vehicle for social control. right865241100Key point: We need to try to understand the reasons for a person’s actions by respecting, understanding and helping them, not diagnosing under a loose fitting definition.What reasons does Szasz give which suggests the medical model is unacceptable?The causes of mental illness: there is no identifiable cause like an infection, or nutritional deficiency. It is a way of coping. It is a mistake to keep looking for biological causes.No alternative legal approach – government has become involved. Mental illness is not based on scientific research.It denies people freedom and responsibility to choose how to behave. They are coerced and forced into diagnosis and treatment. This is unethical.Diagnosis is subjective, not based on scientific assessment. Mental illness is judging the ‘bad’ behaviour of people.Medical model is dehumanising, ignores suffering of person. Labels are constructed due to medicalisation of disturbed behaviour.Medical model has replaced religious view of mental suffering.Alternative ways – understanding the patient, help them help themselves. Medical treatments do not work, only supress symptoms.Exam questions:In the key research by Szasz (2011), the author refers to “the medicalization of disturbing or disturbed behaviours”. Explain what Szasz means by this. [3 marks]Thomas Szasz suggests that ‘if we accept that scientific definition of illness as the structural or functional alteration of cells, tissues and organs and if all conditions now called mental illnesses proved to be brain diseases, there would be no need for the notion of mental illness’. Explain what he means [6 marks] Debates:According to Szasz (2011) the term ‘mental illness’ refers to the ‘subjective judgements of some persons about the behaviours of other persons’. With reference to the key research, discuss whether or not explanations of mental illness support the idea that psychology is a science [5 marks]With reference to the research by Szasz. Discuss the ethical issues in relation to the research [6 marks]Application: Non-biological treatments for one specific disorderYou must learn two non-biological treatments for depression. These must link with the explanations for mental illness you learned. Cognitive behavioural therapy (linking with the cognitive explanation and the behavioural explanation) *compulsory*Psychodynamic therapies (linking with the psychodynamic explanation) or humanistic therapy (linking with the humanistic explanation) *choose one* Treatment 1: Cognitive behavioural therapy for depressionCognitive behavioural therapy (CBT) is now the most commonly used form of psychological therapy, both in general and in particular for depression.3517265355092000 CBT will take place once a week or once every two weeks. The treatment can last from five to twenty sessions.The rationale of CBT is that our thoughts affect our feelings and behaviour, so by changing our thoughts we can make ourselves better. CBT aims to help patients identify irrational and unhelpful thoughts and trying to change them. The therapy involves showing patients the link between their thinking, behaviour and emotions. (See diagrams)The aim of CBT in the treatment of depression are as follows:3455035575411900To re-establish previous levels of activityTo re-establish a social life To challenge patterns of negative thinkingTo learn to spot the early signs of recurring depressionCBT is collaborative. The therapist and the patient will agree on what the patient wants to change. The therapist may then ask the patient to express their negative beliefs (for example, in relation to their social life). A depressed patient might believe that there is no point in going out as they won’t enjoy it. The therapist may respond to this by vigorous argument to convince the patient that they will in fact enjoy going out.The therapist might also combine behaviour activation, whereby the patient is encouraged to take part in activities they normally enjoy but have ceased to since becoming depressed. The patient may be encouraged to keep a diary of when they engage in activities. If positive experiences are recorded, this can be used next time the patient says there is no point in doing the activity as they think they wouldn’t like it. DEBATES:USEFULNESS OF RESEARCHCBT is extremely useful. It is recommended as the first-line treatment for depression. Butler 2006 reviewed studies of CBT and found 16 published meta-analyses which concluded that CBT was very effective at treating depression. The royal college of psychiatrists recommend CBT as the most effective treatment too.However, if the origin of the patient’s depressive symptoms are not due to thinking (they may have a biological origin), this limits the success of this ‘talking therapy.NATURE/NURTURECBT recognises cognitive explanations which suggest faulty cognitions may cause depression. For example, underlying cognitive structures (nature) that are influenced by learning and experience (nurture). CBT recognises behaviourist explanations which suggests that mental illnesses are entirely down to a person’s nurture. For example, that a person’s addition to gambling or a phobia is due to the environment. Elements of cognitive and behavioural are considered and influence CBT, thus considering both sides of the debate.FREEWILL/DETERMINISMThe behaviourist explanation (which helps shape CBT) is deterministic. This is because maladaptive behaviours are down to the environment. It suggests we have no control over this. This is a positive when looking at treatmentsHowever, the cognitive approach (which helps shape CBT) believes that it is the way in which we think about a situation which causes these negative thoughts and behaviours. This, again, can be positive when looking at treatments.PSYCHOLOGY AS A SCIENCEBehaviourists approach is scientific. They seek to find a causal link between an event and an outcome. For example, a frightening experience of near drowning could cause a phobia of the water.Cognitive explanations are harder to prove. These often heavily rely on self-report of these cognitive distortions. Treatment 2:DEBATES:USEFULNESS OF RESEARCHNATURE/NURTUREFREEWILL/DETERMINISMPSYCHOLOGY AS A SCIENCEExam questions:Outline one non-biological treatment for one specific disorder (5 marks)Outline how the behaviourist approach could be used to explain mental illness. (5 marks)Compare a cognitive explanation with one other explanation of mental illness. (10 marks)To what extent are explanations of mental illness reductionist? (10 marks) ................
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