Module 6 Flashcards
(155 cards)
1
Q
OVERSEAS FILIPINOS
A
- More than 10 million overseas Filipinos worldwide
- Overseas Filipino Workers (OFW) or temporary overseas workers
- Irregular overseas Filipinos
- Permanent overseas Filipinos
2
Q
- A Filipino who is employed to work outside the Philippines
- Staying overseas is employment related and they are expected to return at the end of their work contracts
A
OFWs or temporary overseas workers
3
Q
- Those who are not properly documented or without valid residence or work permits or who are overstaying in a foreign country
A
Irregular overseas Filipinos
4
Q
- Immigrants or legal permanent residents abroad
- Stay does not depend on work contracts
A
Permanent overseas Filipinos
5
Q
- 1900’s
- Thousands fled because of the widespread poverty brought by the Philippine-American war
- Hawaiian plantations
- By 1934, there were about 120,000 Filipino workers in Hawaiian plantations
- Characterized by migration to the US with the option to stay there for good or to return to the country
A
First Wave
6
Q
- Characterized by an outflow of professionals to the US (Doctors, dentists and mechanical technicians)
- Migration primarily induced by the desire to “look for greener pastures”
- By 1975, more than 250,000 Filipinos have migrated to the US
A
Second Wave
7
Q
- Economic boom brought about by the dramatic increase in oil prices enabled oil-rich countries in the Middle East to pursue developmental projects
- Characterized by short-term contractual relationships between the worker and the foreign employer
A
Third Wave
8
Q
Geometrical growth in the number of labor migrants:
A
1971 – 1,863 1976 – 47,835 1983 – 434,207 1984 to 1995 – 490,267 annually Highest worker deployment in 2012 at 2,083,233
9
Q
PHILIPPINE MIGRATION PROFILE
A
- Today, the Philippines is the largest organized exporter of labor in the world
- 8 million OFWs worldwide
- 10% of the total population
- Working in 193 countries
- Each year, the Philippines sends out more than a million Filipinos
- Doctors, accountants, IT professionals, entertainers, teachers, nurses, engineers, military servicemen, students, domestic helpers, housekeepers, caregivers, seafarers and factory workers
10
Q
Overseas Migration Trends (1)
A
- There are more Filipinos who leave the country for temporary contract work than those who leave to reside permanently abroad.
- The predominance of the Middle East as a work destination in the 70’s and early 80’s gave way to the emergence of Asia as increasingly important alternative destinations for Filipino labor in the mid-80’s and 90’s.
11
Q
Overseas Migration Trends (2)
A
- Females dominate migrant deployment since the 80’s.
- 65 to 70% who leave the country are women
- From deploying production, transport, construction and related workers in the 70’s and mid-80’s, deployment has shifted to an ever increasing proportion of service workers, particularly domestic helpers in the mid-80’s and 90’s.
12
Q
THE BREADWINNERS: FEMALE MIGRANT WORKERS
A
- Only in the Philippines do women constitute a large part of the workforce
- 1992: 51% of newly-hired overseas workers were women
- 1994: the figure had risen to 60%
- 1999: 64%
- Filipino women rank among the most mobile or migratory in Asia
13
Q
THE BREADWINNERS: FEMALE MIGRANT WORKERS
A
- Many male Filipino migrants work in construction
- This sector has been shrinking owing to an economic slowdown in the Middle East and the Asian financial crisis
- Jobs filled by Filipino women are less likely to be filled by women from host countries
- Demeaning work
- Domestic help: large portion of Filipino overseas workers
- Caregiving
14
Q
(GAINS)
Financial contribution through remittances
A
- OFWs brought in over US$62 billion from 1990 - 2003
- In 2004, the Central Bank of the Philippines reported a total remittance intake of US$7.6 billion
- 2005 - more than US$10 billion
- 2012 – more than US$21 billion
15
Q
(GAINS)
Financial contribution through remittances 2
A
- Female overseas workers tend to remit 71% more than their male counterparts
- Tend to send all they can to help their families
- Filipino workers in HK, mostly domestics, sent home $36 million during the first 2 months of 1995
- The more numerous and largely male Filipino overseas labor force in Saudi Arabia remitted only $1.2 million
16
Q
(GAINS)
Increase in the income for individual families
A
- Overseas work enables many Filipino families to buy expensive appliances, buy new homes and send children and siblings to school
- Between 22 to 35 million Filipinos, 34 – 53% of the total population
- Directly dependent on remittance from migrant workers
- Overseas migrants are able to help other family members in ways that would not be possible, if they stayed in the Philippines
17
Q
Tacoli Study (1996) of Filipino migrants to Rome
A
- Mothers send home the equivalent of 6.4 monthly salaries every year, higher than the 5.5 monthly salaries contributed by the fathers
- Among single workers, daughters also remit bigger amounts and on a more regular basis compared to sons
- Reveals the financial consideration in the decision to move, but underlying this is the family’s desire for social mobility
18
Q
(Tacoli Study)
The process of social mobility takes the following forms:
A
- Investment in the schooling of the children to enable them to go to exclusive and expensive private schools and universities
- Funds for the purchase of land
- Capital to set up a small business managed by the family
- Jeepney transport
- Sari-sari store - Money to build or buy a home for the household or to rent out
19
Q
- Migrant family is better off economically than the non-migrant family
- Financial support from abroad is beneficial to the extended family
- Large houses, vehicles, education of the children, farms, money-lending business, livestock-raising, jeepney and school bus operations are all sourced from earnings of migrants
A
Concepcion study (1998)
20
Q
Problems of OFWs
A
- Pre-departure
- On-site
- Return migration
21
Q
- High cost of placement fees
- Lack of information on policies of host country
- Lack of preparation of migrant workers and families
- Illegal recruitment, deployment or departure
- Lack of domestic economic and employment opportunities, as well as limited job options
A
Pre-departure
22
Q
- Abusive and exploitative work conditions
- Contract substitution
- Inadequate mechanisms on protection, and compliance monitoring of these
- Limited on-site services for OFWs
- Ill-attended health needs
- Rampant trafficking of women
- Social and cultural adaptation problems
A
On-site
23
Q
- Incidence of violence
- Inadequate preparation for interracial marriages
- Lack of welfare and other officials to attend to migrant workers’ needs
- Lack of support or cooperation from government of host country
A
On-site
24
Q
- Lack of opportunity to absorb returning migrant workers
- Lack of savings
- Inability to manage income
- Broken families
- Reintegration problem of women migrant workers
A
Return migration
25
Abuses and exploitation
- Not only are overseas workers beyond the reach of their own countries’ help, they are often denied the protection of international labor standards as well
- Two Filipinos arrive in a box at the Philippine International Airport every day (1996, OWWA)
- 54 Filipinos arrive in a box every month (1997, DFA)
- Reasons for the deaths are varied
- Most of them are Filipino OCWs
26
Abuses and exploitation (2)
- 700 workers, mostly women, die each year following mistreatment by their employers
Most cases of death and abuse against female overseas workers occur in Arab countries
27
Abuses and exploitation (3): Sarah Balabagan, a domestic worker in the United Arab Emirates
- In 1995, stabbed her male employer after he tried to rape her
- Sentenced to death
- International outcry led to the reduction of her term
- Returned to the Philippines after serving 9 months in jail
28
Abuses and exploitation (4)
- Domestic helpers and entertainers are particularly vulnerable to abuse because of their work situation
* Work long hours
* Receive low wages arising from contract violations, contract substitution or deceptive contractual arrangements
* Subject to various forms of physical, psychological and sexual violence
* Jobs generally not covered by the labor codes and social security provisions of the host countries
29
Abuses and exploitation: Saudi Arabia
- Labor laws don’t offer protection to domestic helpers
- No legal rights and no means of seeking redress for contractual violations
- Difficult to escape oppressive working conditions because they need exit passes from their employer before they can leave the country
30
Abuses and exploitation: Singapore
- Domestic helpers are prohibited from marrying Singaporeans or entering into intimate relationships with them
- Undergo pregnancy tests every 6 months
- Deported at their own expense if found pregnant
31
Abuses and exploitation: HongKong
- Domestic helpers have been forced to take a 5% pay cut as a result of the Asian crisis
32
Abuses and exploitation: Korea
- One out of three among 196 foreign women had experienced verbal or physical violence at work (Daegu, Korea)
- Delayed payment, denial of industrial disaster insurance and sexual harassment
33
- Rising exodus of nurses and doctors owing to increased demand abroad
- Dramatic expansion of demand in the computer sciences field
- Exodus of scientists abroad
Brain drain
34
Brain drain
- There is no prevailing policy with regard to managing the brain drain problem
- Government has offered its reintegration program to address the needs of returning skilled migrant workers and harness the skills they acquired overseas
35
Brain drain 2
- Remittances will never recompense the effects of the brain drain phenomenon to the sending country
- Remittances do not go directly to the sectors or professions affected by the exodus of skilled labor
- Will the loss of these human capital, in the long term, undermine the country’s own potential for growth and development?
36
- Many Filipinos tend to seek or accept jobs for which they are over-qualified as long as these can give them higher incomes than they can earn at home
- In 1995, 41.2% of Filipino women migrant workers had a college education or a college degree, yet most of them worked as domestic helpers and entertainers
Deskilling
37
- The quality of the Philippine electorate has been deteriorating over the years as our more educated workforce leave the country
- Relationship between the exodus of educated people and the election of “unqualified” and “popular” candidates into office
”Political loss”
38
Costs of family separation
- Some children develop behavioral problems
- Incidents of drug abuse, delinquency, early pregnancies or marriages are increasing
- Problems tend to emerge in the early teens
* Before that age, children still enjoy the presents they get from parents abroad
* As they grow older, they look for their parents’ affection, guidance and presence
39
Costs of family separation 2
- Guidance, love, concern and care are missed the most
- Feel rebellious and angry at their parents and at the same time crave for their care
- No longer comfortable communicating with their parents
40
Costs of family separation 3
- Infidelity or marital dissolution occurs more often among couples separated for long periods
- Women spending their husband’s earning on their lovers; men frequenting beer houses and womanizing
- Husband lives in with another woman to whom the remittances and appliances sent by the wife are given
41
Causes of separation and abandonment among families of OFWs, mostly wives of workers in the Middle East, are rising
- Prolonged separation
- Lack of communication
- Difficult living and working conditions
- Lack of emotional and social support
- Emotional and mental pressures
- Falling out of love
42
Costs of family separation 4
- OFWs in the UAE use fake certificates to remarry, sink into debt and eventually abandon their family back home
- POEA had more than 2,500 cases of non-support from 2000-2002
- Some husbands remain faithful and even stop working in order to take care of the children and domestic tasks
- Arcinas and Bautista study (1988) of determinants of successful labor migration in the Gulf area
* Wives of husband migrant workers not only managed to keep the family intact but also successfully maintained and expanded the household’s entrepreneurial activities, thereby maximizing the benefits of their husband’s overseas employment
43
Costs of family separation 5
- Marital breakdown is avoided through the efforts and determination of the migrant wives to keep the family intact with their tolerance, perseverance in their work and prayers
- Children help bind the marriage by promoting amicable settlements between their parents
44
Concepcion study (1998) on the impact of female overseas employment in a labor exporting community: Family structure changes
- Majority of the households are incomplete with 1 or both parents absent
- Other households become re-expansion households where children of migrants live with and are cared for by aunts or grandmothers
- Virtual or imagined households with both parents abroad and the children distributed among relatives
45
Concepcion study (1998) on the impact of female overseas employment in a labor exporting community: Changes in roles
-Housechores taken over by the husband, older children (usually a daughter) or the extended family kin
46
Concepcion study (1998) on the impact of female overseas employment in a labor exporting community: Strained relationship between husband and wife
- Understanding and acceptance of extramarital affairs on the part of the migrant
- More social control on the non-migrant spouse
47
Concepcion study (1998) on the impact of female overseas employment in a labor exporting community
- Conflict among in-laws over guardianship of the migrant’s children, over control in the use of the migrant’s car, over access to the farm harvest, or over remittances meant for one but sent through another
- Pain of separation between biological parents and their children, and between surrogate parents and the children upon the migrant’s return
48
Concepcion study (1998) on the impact of female overseas employment in a labor exporting community 2
- On the whole, families able to cope and adjust to the situation with the support of the extended kin
- Family merges itself with a larger circle of relatives, not necessarily co-residentially nor having to share eating arrangements, but to share chores and give emotional and moral support to one another
49
I DO BIDOO BIDOO: Characters
- Pol: “One hit woder”
- Rose: “nakakahiya” “unahin ang pag-aaral”
- Nick: “satin ang babae…”
- Elaine: “ayaw ko matulad ka sa akin.”
- Rock: “bakit tayo dukkha.”
- Tracy: “I will not apologize for being this way."
50
- Seeks not only to treat the individual symptoms, disabilities, and vulnerabilities, but the meanings of those and their role in the overall functioning of the personality – Kaplan
- Probably this what you have in mind, somebody sitting behind you, you lying in a couch… ventilating your concerns… once the doctor says, ahuh I see, tell me how you feel.
Individual therapy
51
- Any intervention that focuses on altering the interactions among family members and attempts to improve the functioning of the family as a unit of individual members. The clinician attempts to interrupt rigid intergenerational patterns that cause distress w/in or b/w individuals. This can address the concerns of any family member, yet it is most likely to influence children, whose daily reality is affected by family context. – Kaplan on Child Psychiatric Treatment Ch 48
- Whole family or couple (marriage) comes into therapy
- Child brought to doctor because child has problem, only to find out that the couple has conflict
Family Therapy
52
- Couple comes into therapy. When you’ll get married, have some counseling
- Problems in communication intermarriages.
Couple therapy
53
Stages of the Family Life Cycle
- Leaving Home: single young adult
- The joining of family through marriage: The new couple
- Families with young children
- Families with adolescents
- Launching children and moving on
- Families in later life
54
- Murray Bowen
- Differentiation of self
- Emotional triangles
- Family projection process
- Multigenerational process
- Emotional cut-offs
Bowen Family System Theory
55
- Autonomous with ego strength
- Capacity to think and reflect
o Ego balances between superego(conscience)
o and id (drive)
o Someone with weak ego strength can easily moved to emotionality, nagwawala, regresses to childhood
o Differentiated synonymous to“mature”
Differentiation of self
56
- Easily moved to emotionality
- React with submissiveness or defiance
o Agree with everything you say or argue with everything
o Overly defiant (mahilig kumontra) or overly submissive (oo lang ng oo)
Undifferentiated people
57
- The way people manage undifferentiation
- The greater the emotional fusion between parent and children, the greater likelihood of cut-off.
-"We take it as a sign of growth to separate from our parents and we measure our maturity by independence to family ties.” –Michael Nichols
o The way people manage undifferentiation
o The greater the emotional fusion between parents and children, the greater likelihood of cut-off
o Someone who is totally differentiated tends to exaggerate their independence
Emotional Cut-off
58
- When two people have problems they are unable to work out
- Will turn to someone else for sympathy / or will draw in a 3rd person who will try to fix it
- Let’s off stream but freezes the conflict in place
Triangulation
59
o Not entirely bad if they don’t remain fixed. You as a therapist should know how to get out.
o Nakakabawas ng anxiety at some times, but when unresolved, minsan lalong nakakasama
o Look at parents with conflict; they tend to look at their child as the 3rd person.
* Nick has problem with Elaine, Elaine masyado
syang naghover kay Tracy (naging substitute
spouse or emotional husband). Masyadong
tutok ang magulang sa child, child gets
undifferentiated
Triangulation
60
- Process by which parents transmit their lack of differentiation to their children
- Husband who is cut-off from his parents and siblings relates in a very distant relationship to his wife
- This predisposes her to focus on her kids
Family Projection Process
61
o Elaine also had an unplanned pregnancy before, which was Tracy. Marriage is not a solution if you are both undifferentiated people. Sometimes waiting for the right time is a good solution.
o Family genogram- look at patterns, early marriages, nagging wives, similar patterns between generations
Family Projection Process
62
- Less differentiated people marry they select a mate about same level of differentiation
- The level of anxiety in the new family will be higher
o Like Nick and Elaine, and Pol and Tracy , the level of conflict increases as level undifferentiation increases
Multigenerational Transmission Process
63
Structural Family Therapy
- Salvador Minuchin
- Argentina
- “When Minuchin speaks families listen”
- Boundaries
64
- are unwritten rules that define the family
interactions, stating who participates and how
*Can children of the household express their
anger to parents?
*Can a parent form a coalition with a child
against the other parent, if so what happens?
*Can grandparents discipline children when a
parent is in the room?
Boundaries
65
- There are so-called GOOD BOUNDARIES
- This is the boundary needed to permit “space” for personal growth
- Thoughts and feelings are respected
- Individuals are not confined to a limited acceptable range of behavior
- Differences are accepted in a family as a natural consequence of unique personalities.
Interpersonal Boundaries
66
Boundaries: Enmeshment
- Indecisiveness
- Interrupting others
- Speaking for other family members
- Doing things for children they can do for themselves
- Constantly arguing
- Dependent
- Loving and attentive
- Problem relating outside the family
67
Boundaries: Disengagement
- Reactive
- Total absence of conflict
- Surprising ignorance of important information
- Lack of concern for each other’s interest
- Independent
- But Isolated
- Little affection
68
Assessment of maturity (1-4)
- Rate you and your partner’s emotional maturity
1-10 scale (1=lowest; 10=hghest)
My rating ________ : Partner’s rating________
1. Balance of independence and dependence
2. Equal capacity to give and receive
“Puro give give give or puro receive lang”
3. Competing and comparing have been outgrown
“Kayo ba ang couple na nagpapataasan pa ng
grades?”
4. Independence from family or origin has been
achieved
“Extended adolescence ang pagaaral ng
Medicine, so this may be hard for you guys.
69
Assessment of maturity (5-8)
5. Sexual maturity is evident
6. Hostilities have been resolved and have been rechanneled to more productive pursuits
7.Biases and prejudices have been de-mystified and rose-tinted glasses have been removed
8. Flexibility and adaptability are manifested
total_____
65-80 Highly mature
41-64 Moderately mature
40 and below immature
70
What will you bring in a relationship? Genogram (Father)
Father:
For men: what ways would you be like your father in his role as a husband? As a father? In what way do you want to be different?
o Do you want to be strict like your dad or liberal ba?
For women: In what ways is your partner similar or different to your father? How do you want your husband to be a husband and father?
o Is he as funny as your dad? Or is he the same age as your dad?
71
What will you bring in a relationship? Genogram (Mother)
Mother:
For women: what ways would you like to be like your mother in her role as a wife? What way would you like to be different? What help do you want to be different?
o Do you want to be as nurturing? Or do you want to be a punching bag?
For men: what qualities do you like in your mother? What qualities do you not like? I what way similar or different to your mother?
o Gusto mo mahilig magluto? Maglaba? Or maglinis? Or do you hate your GF being like a nagger like your mom?
72
Faith
1. What is your faith?
2. How important is that in your life?
3. Do you practice your faith?
*Pano kung different ang religion ninyo? Muslim siya, Roman Catholic ka. There are certain instances wherein the in laws would become the cause of anxiety for the patient because of the barriers on perception about religion.
73
- The road map how to live your life
- What are the top 5 values in your life?
- Which are negotiable and non-negotiable?
- What are your thought on:
1. Couple love?
2. Children’s career
3. Communication
4. Fidelity- Is it an open relationship?
5. Family
6. Faith
7. Finances
8. Sex- Are your love values in line with each other?
9. In-law
Values
74
Lifestyle
- How large was your family of origin? How did this effect the management of your household resources?
- Did you have your own room?
- Did you have a family house or did you live with relatives?
- Was there extra money for occasional treats?
- Celebration of parties simple or lavish?
- Family car or public transportation?
75
- Did your family eat meals together?
- Did you have celebration birthdays, Christmas, etc.?
- Did family members attend your school activities? Sport? Music or school performance?
- Did you celebrate Mother’s day, Father’s day, Valentine’s Day?
- Did you attend church or other religious services together?
Family Traditions and Rituals
76
```
Outgoing-------shy
Always on time---late
Orderly-----disorganized
A planner---easy going
Cheerful---serious
Impulsive---cautious
Adventurous—timid
Flexible---set in ways
```
Personality traits
77
- How do I feel about my level of self esteem?
- What are the unique and loving qualities?
- What areas do you feel inadequate?
- What areas do you have to work on/improve your self esteem?
- In what ways will my self-esteem have an impact on my future marriage
Self Esteem
78
- How does these achievement make you feel about yourself?
- What is your highest academic degree?
- From what institution?
Achievement and Educational Attainment
79
- What attracted you to your previous boyfriends/girlfriends
- What did you contribute to the relationship What did you gain?
- How did your relationship last?
- Why did your relationship end?
Previous Relationship
80
3 Stages of Love
1. Romantic Stage
2. Disillusionment Stage
3. Authentic love stage
81
- loving the other person is effortless
o Everything he/she does is magic
o This is the stage where all the best love song was made. Yung salita niya, pagtawa niya, natumba na nga siya eh cute pa siya eh…
o Because of this unsconscious woman and unconscious man, you tend to project yourself on him/her, and when you look at it you just projected yourself toward the other person
Romantic stage
82
-“Nauntog siya”
o Discovered the weakness
o The stage where the cuteness becomes clumsiness, and everything he/ she does is annoying
o Realizing the projections away from him/her and you see the real person
Disillusionment stage
83
- If after discovering the weakness of your partner you decided that his/her assets outweigh the negatives
o Manloloko na siya bago mo siya sinamahan ganun yun, ngayon mo lang napansin kasi natanggal mo na projections mo.
o Important question is do you love him or do you love her, if your answer is no, then this would be authentic love…
Authentic love stage
84
Romantic Love (anima vs animus)
Anima: unconscious feminine soul of a man (with every man is a unconscious woman)
Animus: unconscious masculine soul of a woman (with every woman is an unconscious man)
85
Typical Couple System
1. Pursuer-distancer
2. Blamer-placater
3. Overfunctioner-underfunctioner
86
o Solution is to lessen the distance between the two (Di na maghahabol yung isa, while the other, iiwasan na ang pag iwas)
Pursuer-distancer
87
o Placater- receiver of all blame
Blamer-placater
88
o Allow the underfunctioning to be independent
- child-parent
- alcoholic-enabler
- sick person-caretaker
Overfunctioner-underfunctioner
89
- It is the branch of medicine that studies mental illness.
- As such, it is dedicated to the investigation of abnormalities in brain function.
- The drive of modern psychiatry is to comprehend human behavior as a mind-brain phenomenon
Psychiatry
90
- Medical orientation
- Focus is mental illness or abnormality
- Purpose:
* To define and recognize illness
* To identify methods for treating them
* To develop methods for discovering their causes and implementing preventive measures
Psychiatry
91
The History of Psychiatry
Today, mental illness is considered as a mind-brain phenomenon. But not so in the past
92
- Focus on normal functioning
| - Purpose: To define normality
Psychology
93
Why study the history of psychiatry?
- People today have confused ideas and attitudes about the nature of mental illness.
* Causing the stigma of mental illness.
- To be able to appreciate the evolution of psychiatry from demonic possession to a scientific mind-brain phenomenon.
94
Stages (History of Psychiatry)
1. Biblical – before Christ
2. Classical – Greek, Roman times
3. Post Roman/ Medieval – Dark Ages; 15th-16th centuries
4. Renaissance – 17th century
5. Enlightenment – 18th century
6. Modern Psychiatry – 19th century
7. 20th century
95
What do we study in each stage?
- Nature of psychopathology
- Treatment
- Factors that influenced the definition of psychopathology
96
- Mental illnesses were recognized as discrete illnesses.
Biblical times
97
- Eber Papyrus (the oldest medical document) showed descriptions of mental diseases such as depression and mania.
Biblical times
98
Biblical accounts of individuals with mental illness:
- Saul described as falling into depression
| - King David feigned madness
99
- Despite differences in the classification and pathophysiology of mental illness, the Greeks consistently believed that these conditions were physical in nature.
Classical times
100
(Classical Times)
| Agree about the description of mental illnesses
- Melancholia (depression)
- Mania (a variety of psychotic state)
- Delirium (mental confusion accompanied by fever
- Hysteria (sudden unexplained episodes of pain, sensory loss, paralysis, etc.)
101
- Agreed on the physical nature
- But disagreed on their specific physical causes:
* Hippocrates’ (460-377 BC) - Due to disease in the brain
* Galen - Due to imbalances in the body fluids
Classical times
102
- Through the influence of the Christian church, the emphasis was on saving souls, not bodies.
Middle Ages/ Dark Ages
103
- Mental illness:
*Possession by the devil
*Just punishments for sinful behavior
E.g. Depressed person was spiritually ill.
- Treated through the church rather than through medicine; tortured or burned at stake
Middle Ages/ Dark Ages
104
- The rebirth of interest in the classical teaching brought a fresh way of looking at phenomena, including mental illness.
Renaissance: 17th Century
105
- Opposed witchcraft and diabolical interpretations
- Implicated nerves/brain as site where mental disturbances lay
- Foundations of modern psychiatry were being lai
Renaissance
106
- But mentally ill were still inhumanely treated in asylums.
Renaissance
107
- Conditions for the mentally ill were mostly woeful
- Water cure as a primitive kind of shock therapy
- Patients were locked up; put in chains
- Mentally ill were mixed up with the criminal, the mentally retarded and the poor.
Renaissance
108
- All over the world, the weak, deprived and powerless sought to take back their rights and to seize authority from the rich and powerful.
18th Century: Age of Enlightenment
109
- the founder of modern psychiatry
* removed the chains from the psychiatric inpatients
* Instituted “moral treatment”
Philippe Pinel
110
- Tried to approach the study of psychiatry scientifically
- Mental illness was caused either by hereditary factors or by “intolerable passions” such as fear, anger, grief or elation.
- Emphasized empirical observation
- Established epidemiological methods
- Diagnostic schema
18th Century: Pinel
111
- The First Era of Neuroscience
| - The Development of Psychoanalysis
19th Century: Modern Psychiatry
112
- Brain was studied scientifically for the first time: anatomically, microscopically, functionally
- Landmark achievements in neuroscience: mapping of the brain
- Mental disease must stem from abnormalities of brain cells
- Kraepelin emphasized precision and objective diagnostic criteria for mental illness.
19th Century: First Era of Neuroscience
113
- Attitudinal shift towards romanticism; focus was on dreams, sexuality, and hidden desires
- Freud observed clinical phenomena and combined these with speculations and hypotheses about psychic mechanisms
* tripartite model of the mind
* a new therapy for the psychoneuroses
19th Century: Development of Psychoanalysis
114
- Parallel developments in psychology, psychiatry and neuroscience
- 2nd Era of Neuroscience
20th Century
115
20th Century: Developments in Psychology
- Psychoanalysis: “Three Theories of Sexuality”; :Inhibition, Symptoms and Anxiety”; Ego Psychology; Object Relations Theories
- Behaviorist movements: Skinner
- Psychometrics: MMPI, Stanford-Binet …
116
20th Century: Developments in Psychiatry
- Diagnostic and Statistical Manual
- Schizophrenia research
- Normal intellectual development: Piaget
- New conceptions in sexuality
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- Discovery of drugs for the treatment of schizophrenia (chlorpromazine) and depression (imipramine).
- Discoveries on neural functioning
- Microscopic techniques for neuronal studies
20th Century: Second Era of Neuroscience
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Summary
- No consistent agreement about the origins of mental illness, its treatment and the role psychiatrists play in it
- The factors that determine the definition of mental illness are numerous, interacting in a complex manner.
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Conclusions
- The confusion about the origins of mental illness remains despite the scientific advancements that establish the brain as the organ of the mind
- Old beliefs with evil connotations of mental illness still persist. This leads to the stigma of mental illness.
- Contemporary psychiatrists ascribe to the biopsychosocial concept of mental health and illness.
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- is the state of complete, physical, mental and social well-being and NOT merely the absence of disease or illness
Health
121
- Embodiment of social, emotional and spiritual well-being
- Provides individuals with the vitality necessary
* for active living,
* to achieve goals and
* to interact with one another in ways that are respectful and just
Mental Health
122
- Interfere with a person’s cognitive, emotional and/or social abilities
- Compared to mental disorders
* Have lesser impact
* More common
* Include emotional states experienced in reaction to life’s stresses
* Less severe and shorter duration
- May progress to a mental disorder
Mental Problem
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- Diagnosable disorder
- Significantly interferes with an individual’s
(cognitive, emotional and/or social abilities)
- Different types and different severity
- Public health issues:
*depression,
*anxiety,
*substance use disorders
*psychosis
Mental illness/disorder
124
- A new method for establishing a single measure of health status
- Measures health in terms of functional impairment and disability instead of mortality.
Burden of Disease
125
Mental illness is a serious condition.
- “ The burden of mental illnesses … has been seriously underestimated
- Traditionally, a disease was considered serious if it causes many death.
- Today disability is the measure of seriousness.
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Mental illness is a serious condition.
- Among women in developed countries aged 15-44, leading causes of disease burden are:
* Unipolar depression
* Schizophrenia
* Road traffic accidents
* Bipolar disorder
* OCD
- Depression will produce the second largest disease burden in the year 2020
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Mental illness impacts:
- Individuals
- Families
- Communities
128
The Social Impact of Mental Illness on Individuals
- Suffer
* from stigma
* from symptoms
* inability to participate …
- Worry about responsibilities…
- Fear being a burden to others
129
The Social Impact of Mental Illness on Families
- One in four families with mentally ill member
- Impact:
* Provide physical and emotional support
* Emotional reactions to the illness, stress of coping with disturbed behavior, disruption of household routine
* Restriction of social activities
* Bear stigma
130
The Social Cost of Mental Illness
- Out of role
* cannot undertake normal activity because of health problems including going to work-
- Three days out of role over a four week period
- Thirty days out of role over one year
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The Economic Impact of Mental Illness
- Reduced productivity
- Lost wages
- Create or worsen poverty
- Increased number of accidents
- Increased need of supporting dependents
132
The Economic Costs of Mental Illness
- 35% - 45% of absenteeism from work
(WHO 2003)
- Global financial response not proportional to global burden ( 2% vs. 13%)
133
Mental health outcomes for poor
- Socially and economically disadvantaged
*higher rate of mental health problems
2 to 2.5% higher
*1.5 to 2 times more depression
(WHO 2003)
134
Mental health outcomes for specific populations
Women
- increased risk of poor mental outcomes due to:
* Poverty
* Discrimination (Low social status; Traditional female gender roles)
* Violence
135
Global Response to Mental Illness
- "Mental illness , in most countries, is simply not taken seriously.”
40% - no national mental health policy
30% - no relevant action program
20% - no legislation
136
Global Response is less in the Poor Countries
- Less community care facilities
- Less access to drugs in poor countries
* More expensive
* Out of pocket expense
137
Global Response
- 28% of nations have no specified budget for mental health
- Lower investment in mental health
* in Africa and
* SEA
138
Global Response - SEA
- Pioneers in mental health reform
* Community-based programs for mentally ill
* NGOs are active
139
Global Response - SEA 2
- Elements of mental health reform
* Establish new global perspective on mental health
* Incorporate principles of public health
* Make changes in attitudes toward prevention, diagnosis and treatment of mental illness.
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- The concept that states of health and illness are produced by the interaction between biological, psychological, and social factors.
The Biopsychosocial Model of Disease
141
- Applied to the concept of health means:
| that a person’s state of health is the result of the interaction of biological, psychological and social factors
Biopsychosocial Model
142
- Applied to the concept of psychopathology:
| mental health problems and mental illness result from the interaction of biological, psychological and social factors
Biopsychosocial Model
143
- A problem in one aspect affects the others.
- Physical problem leads to psychological problems
- Psychological problem leads to physical problems
Biopsychosocial Model
144
- A person is a system which is simultaneously composed of sub-systems and bigger subsystems.
- Systems Theory (cells, tissues, organs, systems, body, couple, family, community, society
BPS in Psychopathology
145
- Illness is a dynamic process rather than a steady state.
| - The process of illness changes continuously as biological, psychological and social factors interact.
BPS in Psychopathology
146
Examples 1
Psychological distress precedes the onset of a variety of physical illnesses
- History of loss, hopelessness and depression leads to leukaemia, lymphoma, uterine CA, lung CA
- Depressed heart surgery patients had lower rates survival
- Six months after the loss of as spouse, mortality from heart disease increases
147
Examples 2
Your personality style could make you sick.
- Certain personality styles may predispose a patient to characteristic responses to stress or may be associated with a lifestyle which leads to illness
- Type A Personality: closely associated with coronary artery diseas
148
Examples 3
Psychiatric illness may represent a psychological reaction to the significance of a physical illness
- Psychological Reaction to Physical Illness
* Depression is chronically ill, terminally ill
149
BPS Factors in Mental Health and Psychopathology
1. Biological
- Genetic
- Neurochemical, neuroendocrine, and psychopharmacological
- Biological rhythms
2. Psychological
- Conflicts
- Defense mechanisms
- Object relations
- Self-esteem
3. Social
- Socio-economic status
- Family structure
150
Clinical Implications (BPS)
- To treat psychopathology, we must take a systems approach
- Sometimes, sources of stress do not always come directly from within or even close to an individual.
- Sometimes, the stress comes from outside the individual
151
Clinical Implications (BPS) 2
- Thus, the most effective interventions in any clinical situation might not necessarily be directed at the identified patient.
- They can be directed at the family the community or the society
152
BPS Model in Psychopathology: Multiple Etiology
- The aetiology of psychopathology is multi-factorial: biological, psychological, social
- Not single aetiology
153
BPS Model in Psychopathology: Risk Factors
The risk factors of psychopathology are:
- biological,
- psychological
- social
154
BPS Model in Psychopathology: Manifestations
- The manifestations of psychopathology are:
1. Biological (Sleep impairment, Impaired appetite)
2. Psychological (Hallucinations, Delusions)
3. Social (Social isolation)
155
BPS Model in Psychopathology: Treatment
The treatment interventions for psychopathology are:
1. Biological (Pills, ECT)
2. Psychological (Psychotherapy, Psychoeducation)
3. Social (Assisted living)
