lecture 2- issues in mental health Flashcards
(21 cards)
History of psychological disorders 1
Ancient times: mental disorders attributed to possession by demons/gods treated though exorcism
Greek and roman thought 400BC
Mental disorders had natural causes and brain is central organ of mental activity. Treatments involved life style change. Understand importance of heredity.
China:
Belief in Yin- and Yang + forces within the body
Early middle ages:
Greek ideas in the middle east and mental hospitals set up. Avicenna looked into hysteria, epilepsy, manic reactions.
Europe in early middle ages:
Lack scientific thinking + churches gained influence. Treatments: priest breath, holy water, exorcism
Late middle ages/ renaissance
Scienfitic questioning. Asylums established and mentally ill confined
Bedlam: hospital with crude and painful treatment
History of psychological disorders 2
Humanitarian reform:
Phillipe pinel
Removing chains and treat them better, release inmates in dungeons for up to 30 years.
William Tuke and Benjamin Rush promoted treating people kindly to help recovery. Moral management focusing on individual needs- 45% success rate in bedlam
19th century:
Asylums controlled by laypersons and moral management was treatment on offer.
In late 19th century psychiatrists had more influence on treatment and there were vague definitions for mental health conditions
20th century:
1946 onwards greater attention to care in hospitals.
Mary Jane Ward’s The Snake Pit let to state reform
Later, de-institutionalisation to close mental hospitals and instead provide more human and integrated community care. Also new medicine
DSM-5 Critics
Increase rates of mental disorders by reducing thresholds for existing disorders and introducing new disorders at the boundary with normality.
How many more mental health conditions are now part
What is/isnt normal behaviour
Are conditions natural
How can we define the disorders
Foucault’s argument
Not interested in the event of the confinement but in attitudes and perceptions towards madness connected with practise of confinement
Those are not considered to be following societal norms in regards to mental health, sexual practices and religious practices
Confinement as an economic polic
To deal with poverty, begging and unemployment getting a larger class of potentially disruptive people off the streets and putting them to work in a controlled environment
Those confined were seen as moral troublemakers worth of societies’ condemnation and punishments rather than victims of unfortunate economic processes
Movement of morals to science
19-18th century there were new scientific views such as humanisation of treatment
Madness is a disease of the mind and madness is something ‘other’
20th century: stereotypes still exist in diagnosis, treatment and social acceptance of those with mental-health conditions
The anti-psychiatry movement
Psychiatry was found on a false epistemology: mental illness diagnosed on the basis of behaviour/conducted but treated biologically.
Not focused on what the symptoms say about how the person is coping.
Diagnosis comes with stigma.
This lead to challenge of the core values of Psychiatric establishment and thought that society may be part of the cause of the illness
2 central contentions of the anti-psychiatry movement
1) specific definitions of or criteria for current psychiatric disorders. Leaving too much room for interpretations and opinions rather than scientific standards
2) Prevailing psychiatric treaments are ultimately more damaging than helpful
4 key criticisms of current psychiatric establishment
Inappropriate and overuse of medical concepts (too much emphasis on biology)
Ill-founded system of categorical diagnosis and stigmatisation
Abuse or misuse of power over patients often treated against their will
Compromise of medical and ethical integrity because of psychiatrists financial and profession links with pharmaceutical and insurance companies
Approaches to the concept of mental disorder
The myth of the myth of mental disorder
Disorders as a pure value concept
Disorders is whatever professionals treat
Disorders as statistical evidence
Disorder as biological disadvantage
Disorders as unexpectable distress of disability
Wake-field disorders as a harmful dysfunction
The myth of the myth of mental disorder
There is no such thing as mental illness and it is a label which justifies the use of medical power to intervene in socially disapproved behaviour.
Psychodiagnosis is used to control and stigmatise socially undesirable disorder which is not really disordered.
Often sexual, racial and sexual orientation bias in disorders.
Szasz 1974: mental disorder only exists if the concept of disorder that applies to physical conditions also applies to mental conditions
However, psychological functioning is not accompanied by any identifiable lesion. A lesion is only a disorder if it impairs the ability of the anatomical structure to accomplish the functions it is designed to perform
Disorder as a pure value concept
Disorder is a value concept and social judgements of disorders are nothing but judgement of desirability according to social norms and ideals.
There is truth in this statement however does not consider the cause of the disorder
Disorders is whatever professionals treat
A disorder is something of therapeutic concern for a person either felt by the person himself and/or thier social environment.
However many treatable conditions are not disorders (distress due to divorce or events in life)
Implies that lack of social concern can eliminate disorder
Kendell 1975: equating illness with therapeutic concern implies no on can be ill until he has been recognised as such
Disorders as statistical devicane
Cohen 1981: disease as quantitative deviations from the statistical norm.
Must be in the negative direction- High IQ is not bad
But many undesirable behaviours are not disorders like being a criminal, immoral or ignorant.
Statistically deviant does not equal disorder but many disorders are statistically deviant
Disorder as a biological disadvantage
According to evolution theory disorder is anthing that reduces longevity or fertility.
But a condition can reduce fertility and not cause harm OR cause harm but not reduce fertility
Fertility rates differ between populations
Does not distinguish between disadvantages due to dysfunction and external factors
Disorders as unexpectable distress or disability
Must cause psychological/ biological or stress causing dysfunction is.
However does not define what dysfunction is.
A child diagnosed with oppositional defiant disorder when during a 6 month period he displays defiant behaviour at a rate that is considerably more frequent than that of most people of the same age.
This confuses normal variation with disorder.
Those who experience traumatic events are diagnosed with PTSD- a disorder. But is it a disorder and not a plausible reaction?
Wakefield- disorders as a harmful dysfunction
Concept of disorders must include factual component to distinguish them from other disvalues conditions.
Disorders require harm, which involves harm.
Fact and values must both be considered.
What is natural function of mental mechanisms
Selected for a purpose e.g.
linguistic mechanisms for communication (Aphasia)
Fear response to avoid danger (phobia)
Tiredness to get sleep (insomnia)
Something wrong with mechanisms leads to disorder
So dysfunction is failure of mechanisms to perform its’ natural function-Darwin
Why is dysfunction not enough?
Natural functions of internal mechanisms were determined by selective pressures in radically different environment
These selective pressures have changes- breakdown in function of a mechanism may not have negative consequences it once had.
Dysfunction must also cause significant harm to the person under present circumstances.
Therefore only dysfunctions that are socially disvalued are disordered
Wakefield’s definition of a disorder
Must:
1) cause harm or deprivation of benefit as judged by standards of person’s culture- value criterion
2) result from inability of some internal mental mechanism to perform it’s natural function
According to DSM definition, disorder is the behaviour displayed rather than the actual difficulty within performing mechanisms causing problem/phobia
