P3 - M.H. - Historical Context of Mental Health - Rosenhan Flashcards
(40 cards)
1
Q
Historical views of mental illness
A
- Demonic possession and witchcraft.
- Madhouses and bedlam; mentally ill seen as wild animals.
- Late eighteenth century – emergence of psychogenesis – link between psychology and biology as causes.
- Early 1900s – Psychoanalytical theories and Biological theories develop.
- Behavioural theories develop in the early 20th century.
- Humanistic & Cognitive theories 1950s onwards.
- 1950s – asylums renamed mental hospitals. Rise in drug therapy.
2
Q
Trepanning
A
- The process of drilling holes into the skull to release demons.
- Skulls dating back to 6,500BC
- Some of the skulls have healed, suggesting that some people survived the ‘treatment’.
3
Q
Madness
A
- The idea of madness has been around for a very long time.
- The term ‘madness’ features in the Old Testament and this was perceived as a punishment from God.
- Some treatments have used exorcisms to rid the patient of evil spirits.
4
Q
Hippocrates
A
Hippocrates was the first to suggest that mental illness was a scientific phenomenon.
He suggested that madness was caused by an imbalance of the four bodily humours and could be treated by balancing these four humours:
* Blood
* Phlegm
* Black Bile
* Yellow Bile
5
Q
Impact of the Church
A
- The Greeks continued to investigate mental health as an imbalance but with the growth of the Christian Church in 300AD, the idea of madness as a punishment from God became the dominant theory.
- Religion was also the primary care system; such as the Bethlem Hospital in London.
6
Q
The Middle Ages
A
- In the 1300s and 1400s the burning of witches reached its peak.
- As time went on some believed that these burnings were not related to witchcraft but forms of mental illness, such as hysteria and epilepsy.
7
Q
Moral treatment
A
- As we move through history, the treatments become more patient focused.
- The role of emotions and exposure to stressors became more important.
- This treatment involved:
respect for the patient, a trusting relationship between patient and doctor, a calm environment & a routine.
8
Q
19th century
A
- This century saw the rise in the number of mental hospitals in North America and Britain.
- Psychiatry became a recognised medical speciality.
9
Q
Modern psychology
A
- Beginning in the 1890s, modern psychology has seen many different approaches to mental health.
- Freud’s theories of the unconscious, the humanistic beliefs of self-worth and the behaviourists’ ideas of learned behaviour are just three of the many differing views of the last and this century.
10
Q
Statistical Infrequency
A
A behaviour found only in people 2 or more Standard Deviations from the Mean
11
Q
Acting against social norms
A
- Social norms are expected approved ways of behaving.
- If a man were to dress like it was winter when it was 30 degrees outside, he would be seen as abnormal.
- If abnormality is seen as any behaviour which deviates from social norms, can we conclude that this behaviour indicates the presence of a psychological disorder?
- Why might you have to be careful with this definition, especially when thinking about different cultures?
12
Q
Failure to function adequately
A
- Under this definition, a person is considered abnormal if they are unable to cope with the demands of everyday life.
- They may be unable to perform the behaviours necessary for day-to-day living, e.g. self-care, hold down a job, interact meaningfully with others, make themselves understood, etc.
13
Q
Deviation from ideal mental health
A
- Under this definition, rather than defining what is abnormal, we define what is normal/ideal and anything that deviates from this is regarded as abnormal.
- To have an ideal mental health the patient should:
have a positive attitude of themselves and be capable of some personal growth, be independent and self-rewarding, have an accurate view of reality, have positive social interactions with friends and family.
14
Q
Rosenhan and Seligman (1989)
A
This idea was later extended by Rosenhan and Seligman (1989) to include the following explanations for abnormality:
- Suffering – a person has negative consequences of their behaviour.
- Maladaptiveness – not fitting in with society and maintaining normal social contracts.
- Unconventional behaviour – something that wouldn’t be expected by society.
- Irrationality in behaviours that others wouldn’t be able to understand.
- Unpredictability or loss of control that may be unpredictable to the observer or the person exhibiting the behaviour and is not what we would expect.
- Observer discomfort due to the unpredictability and irrationality of the behaviour.
- Violation of moral standards where behaviour fails to meet the standards set by society.
15
Q
Johoda (1958)
A
Johoda also defined what ideal mental health was:
- Have a positive attitude of themselves.
- Be capable of some personal growth.
- Be independent and self-rewarding.
- Have an accurate view of reality.
- Be resistant to stress.
- Be able to adapt to their environment.
16
Q
Categorising mental disorders
A
- DSM is predominantly used in the US
- ICD is used by the rest of the world.
- The most recent versions of the two books have seen them become closer in their ideas.
- Both are regularly updated in order to change with society, e.g. the removal of homosexuality as a mental disorder from DSM in 1986.
17
Q
Krimsky and Cosgrove (2012)
A
They found that 69% of the panel working on the new DSM-5 had links with the pharmaceutical industry.
18
Q
DSM-5
A
- The DSM-5 contains detailed information on every official psychiatric disorder.
- It provides specific criteria required for diagnosis and a thorough overview of each disorder.
- Ready for use in 2013, includes contemporary disorders, e.g. hoarding.
- Saw the removal of specific types of schizophrenia as these tended to lack reliability and had poor validity.
19
Q
ICD-11
A
- Came into use in 1994
- Used by all member states of the World Health Organization
- Chapter V (F) refers to mental disorders and has 100 categories of disorders.
*
20
Q
Kappa values – Spitzer and Fleiss (1974)
A
- The reliability has also been tested by Spitzer and Fleiss.
- They found an agreement of 0.52 (scored 0 to 1, with 0 being no agreement and 1 being perfect agreement).
21
Q
Different types of Disorders
A
- Affective Disorder – mood disorders such as depression
- Psychotic Disorders – where a patient has lost touch with reality, such as schizophrenia
- Anxiety Disorders – including phobias and PTSD
22
Q
Defining Abnormality
A
- Defining a person or behaviour as abnormal implies something undesirable and requiring change.
- Therefore we must be careful about how we use the term.
- The definition of abnormality inevitably remains a judgement.
23
Q
ROSENHAN - Aims
A
- GENERAL: To investigate the reliability and validity of diagnosing mental illness (using DSM).
- PILOT Study: To investigate how the patient-staff contact compares with student-faculty member contact.
- Study 1: To Investigate whether Sane people would be Misdiagnosed using DSM-2
- Study 2: To Investigate whether labelled Insane people would be Mislabelled Sane because they were expecting to receive Pseudo-Patients
24
Q
ROSENHAN - Sample
A
- The sample were those who were being observed, i.e. doctors, nurses and patients at the two institutions (across five different states on the East and West coast of the USA).
- So, NOT the pseudo-patients!
25
ROSENHAN - Experiment 1
* Participant Observation was used
* Field Experiment
* Sample: Staff in the 12 Hospitals, Opportunity for who was available in the Hospital
* Material: Diary,
* Standardised Instruction: Script ('Hollow', 'Empty', 'Thud' - deliberately not violent), Do not take medication, Record Staff Patient Contact (unstructured instruction), told truth about everything else about them
1. All 8 were admitted (7 Schizophrenia, 1 Manic Depression)
2. Treated Poorly: ave. 11.3% patient interaction, Only 4% of staff stopped & talked to, dehumanised (went to the toilet infront of them) & depersonalised (referred to as number)
26
ROSENHAN - Experiment 1 *Results*
- Once inside the hospitals their normal behaviours were perceived as being reflective of their illness.
- E.g. note taking seen as obsessive writing behaviour, and queuing was seen as oral acquisitive syndrome.
- On average, the pseudo-patients were in the mental homes for 19 days before being able to leave.
min 7 days – max 52 days.
- The real patients recognised them as frauds.
- The pseudo-patients were now participant observers.
- Recording everything they saw and experienced.
- Treatment of those who are mentally ill is different to treatment of those with a physical ailment or disability and is viewed negatively, even by professionals.
- When pseudo-patients asked ‘When am I likely to be discharged?’ the professionals would often ignore them and treat them in an offhand manner.
- Patients felt powerless and depersonalised.
- Their labels had ‘stuck’.
27
ROSENHAN - Recordings
Contact - Psychiatrists in R.'s study - Nurses & attendants in R.'s Study
Moves on, head averted - 71% - 88%
Makes eye contact - 23% - 10%
*Pauses & Chats - 2% - 2%*
*Stops & Talks - 4% - 0.5%*
**No. of Respondents - 13 - 47
No. of Attempts - 185 - 1,283**
28
Pilot Study
- Rosenhan's findings were compared to responses to a young female student approaching a faculty member at university asking questions such as:
- ‘Pardon me, could you direct me to Encina Hall?’
- Do you teach here?’
- Everybody answered the questions and no one ignored her – this was in stark contrast to how the pseudo-patients were treated.
29
ROSENHAN - Experiment 2
* Participant Observation was used
* Field Experiment
* Sample: Staff in the 12 Hospitals, Opportunity for who was available in the Hospital
* 10 point scale
1. 41 were suspected strongly for being a PseudoPatient by at least 1 member of staff - 23 suspected by doctors, some cases multiple doctors agreed
2. HOWEVER there were actually **no PseudoPatients**
193 ppl admitted, 41 suspected of faking
Used as a Quant 10 point scale
19 times, more than 1 staff was wrong on the same person
3 month period, 1 large hospital
30
ROSENHAN - Experiment 2 Results
- **41/193** patients were judged by at least one member of staff as being fake.
- **23** were rated highly confident by at least one psychiatrist and **19** by a psychiatrist and by at least one other member of staff.
31
ROSENHAN - Conclusions
- Rosenhan suggests we cannot distinguish the sane from the insane in psychiatric hospitals.
- DSM-2 was not valid (not accurate in diagnosis) or reliable (not consistent in spotting sane or insane but was consistent in diagnoses – 11/12 diagnosed as schizophrenic). This led to many changes for later versions.
- *Sticky Labels* should only be given out carefully
32
**EVALUATION - Usefulness
ROSENHAN exposed the need for reform to the DSM-2 & difficulty in differentiating the sane from the insane.
* Made an impact on the DSM and exposed the Mental Hospital System & Conditions
33
EVALUATION - Ethics
- Severe Psychological harm to psudo patients who were put into the Psyciatric hospitals
* *Psudo patients were made aware of the aims and experience of the experiment beforehand*
- The Psyciatric hospital workers did not consent to or know that their actions were being recorded, and therefore also could not withdraw
- The Patients in Experiment 2 who were turned away did not know about the experiment, and they still needed help
34
**EVALUATION - Validity
* The experience in a Psyciatric hospital would have been different to a sane and mentally ill individual, and so the conditions may effect mentally ill people worse
*
35
ROSENHAN - Sample Bias
Only in the US (in 5 states); Ethnocentric
However some diversity between different states
36
ROSENHAN - Pseudopatients
* 3 were Psychologists
* 3 Women, 5 Men
* Admitted for 7 - 52 days
* 7 got Schizophrenia diagnosis, 1 Manic Disorder (UNRELIABILITY - Gave Same Symptoms)
* Hearing the same 3 words is not enougfh to diagnose Schizophrenia
37
Participant Observation
* Labelled as 'Obsessive Writing Behaviour' for taking notes
* Most of the Time, the staff were mostly in 'the cage' - a locked work room
* 11.3%/7 mins average of their time spent talking to Patients
* Called Queing for meals 'Oral Inquisitive Disorder'
* Normal Behaviours through the label of Mental Illness seen as part of their Condition
38
ROSENHAN - Method
* Participant Observation was used
* Field Experiment
* Sample: Opportunity Sampling, Staff Members
39
ROSENHAN - Findings
* Study 1: the mental hospitals did a type 1 Error
* Study 2: the mental hospitals did a type 2 Error
40
EVALUATION - Socially Sensitive
ROSENHAN tries to (and helps) to reverse the Stigma surrounding Mental Health
