Paper 3 - Mental Health 3 - Alternative explanations of the Medical Model Flashcards
(29 cards)
1
Q
what are the behaviourist principles
A
- classical conditioning
- operant conditioning
- social learning theory
2
Q
what is the behaviourist explanation of schizophrenia
A
- schizophrenia is the results of faulty learning - operant conditioning
- a lack of positive reinforcement and too much punishment makes the child focus on unusual behaviours that will get them attention that they are not being given
- e.g. focusing on the movement of the mouth when saying words rather than the word itself
- this strange behaviour gets attention - positively reinforced and is repeated along with further strange behaviours
- these are labelled schizophrenic = schizophrenia diagnosis
- punishment leads to withdrawl and more odd behaviours for more attention, other people avoid the child so the strange behaviours increase into a psychotic state (Liberman’s theory)
- this is referred to as Schieff’s labelling theory: The primary deviance is the person’s strange behaviour and the secondary deviance is other people’s reactions which worsen the situation
3
Q
what is the treatment for the behaviourist explanation of mental illness
A
- Allyon and Azrin
- They showed that a combination of praise and token reinforcements could activate these patients to a very large extent.
- making them manageble on wards
4
Q
what is the evidence for Scheff’s labelling theory on behaviourism and schizophrenia
A
- he used Rosenhan’s study as support
- the pseudo patients reporting hearing the words ‘thud’ ‘hollow’ or ‘empty’
- led to a labelling of schizophrenia
- which lead to nurses and doctors ignoring the patients in study 3
- which is a lack of positive reinforcement/ attention
5
Q
what is the cognitive explanation for shizophrenia
A
- internal mental processes - how we think and percieve others and outselves causes mental disorders
- disordered thinking - Frith - schizophrenics are consciously aware of cognitive processes, e.g. thoughts, perceptions that most people are not
- therefore there is a sesnory overload as so much info is being processed consciously leading to attention deficit theory (Frith’s name for this)
6
Q
what is the evidence for cognitive explanation of schizophrenia by Somaia Mohammed
A
- Somaia Mohammed et al compared 94 diagnosed schizophrenic pps recently admitted to a psychiatric warn in USA to 305 clinally normal people
- The pps had deficits in recall, sequencing, organisation, attention, language comprehension, social cognition and stroop performance = cognitive deficits within the symptoms of schizophrenia
7
Q
what is the cognitive neuroscience explanation of schizophrenia
A
- combines a measurement of brain activity with simultaneous performance of cognitive tasks
- Frith - the Septo hippocampal brain circuit (amygdala and hippocampus) stops being regulated by the prefrontal cortex.
- results in patients not being able to tell the difference between internal intentions and external stimuli so the cognitive effect is hearing yout oen inner voice as another persons = hallucination
- Agolia (speech poverty) and incoherent speech stem fro structural and functional abnormalities in the primary auditory cortex in the temperol lobe and the prefrontal cortex which both process meaning of language
8
Q
what is the evidence for cognitive neuroscience explanation of schizophrenia by kuperberg
A
- kuperberg - fMRI scans of 17 chronic schizophrenic patients
- showed increases activity of temperol and inferior prefrontal cortex when looking at semantically related words compared to controls
- the hyperactivity shows those areas are not functioning properly
9
Q
what is the key research in this topic about
A
szasz - the myth of mental illness
10
Q
what does Szasz mean by mental illness is a myth
A
- mental illness is a linguistic rhetorical phenomenon describing behaviour to disturb people
- if metal illness has biological causes then it was never a mental illness but an undiagnosed physical illness
- by describing it is a mental illness medicalises behaviours leading to people being subjected to coercive treatments in hospitals, removing people from society
- criteria for mental illness is controlled by political an economical criteria, e.g. homosexuality was taken off the DMV and ICD - if diagnosis can be changed easily it is not real
- mental illness is a modern pseudo medical perspective on the tragic nature of life
11
Q
when did Szasz publish his book and what is it about
A
- wrote a book ‘the myth of mental illness’ in 1960
- challenging the medical model and psychiatry on the physical causes and treatment
12
Q
to what extent do you agree with Szasz claims
or
evaluate Szasz view
A
- agree - social control of people diagnosed with mental illness
- pharmaceutical industry’s financial interest in seeing more mental disorders discovered
- does not reject biological treatments
- disagree - people are comforted by being given a diagnosis for their experiences
- risks shutting off ways to help people with treatments that people find useful
- Szasz provides no objective quantitative data
13
Q
In Szasz’s book, how has the governments involvement in health care changed
A
- in the 1950s no one felt that it was the governments responsibility to provide health care.
- most people were considered incurable and were kept in mental hospitals
- some patients voluntarily got help and others who could afford it got private treatment
- now, it is the responsibility of the government
- the focus is on a legal requirement to prevent patients being a danger to others and themselves
- there is no legally valid non-medical approach to mental illness
14
Q
In Szasz’s book what does he say about ethics
A
- medical treatment of physical illnesses require patient consent
- but not with mental illness which is a validation of human rights
- a physically ill patients feelings are important and they can accept or reject medical diagnosis and treatment but a mentally ill pps is seen as a danger to themselves and the public and psychiatrist must protect both.
- the ethical principle in medicine is ‘do not harm’ mentally ill patients are judged and treated differently
- psychiatric hospitals are like prisons and patients are treated as prisoners rather than getting treatment
15
Q
what is the application for this topic
A
CBT - Cognitive behavioural therapy
16
Q
what happens in CBT
A
- aims to identify irrational thoughts and change them
- Patients problems are based on incorrect beliefs and expectations
- takes place between 5 and 20 sessions
- can be individual or in groups
- wont get rid of symptoms but will make them cope better
- may involve an arguement or discussion of how likley the beliefs are to be true, and a consideration of less threatening possibilities
- understanding where symptoms come from can provide relief
- offering psychological explanations reduces this anxiety
- therapist wins the trust so they can work together
- honesty patience and unconditional acceptance
- help the pateint realise it is normal to have negative thoughts in certain situations
- so no need to feel stressed or ashamed
- a logical discussion till the pps begins to see where their ideas are wrong and why they developed
- work out ways to recognise negative thougths and test beliefs when they arise and rethink them
17
Q
what are the strengths of CBT
A
- Does reduce releapse in hosptial (NICE 2014)
- Turkington -CBT is highly effective and should be used as mainatream treatment
18
Q
what are weaknesses of CBT
A
- requires self awareness and willingness to engage - symptoms opose self awareness
- lengthly - takes months compared to drugs - pps may be disenaged
- Addington - CBT is of little use in early stages of active schizophrenic episode
19
Q
what is the economic evaluation of CBT
A
- an expensive treatment as it requires special training and qualifications
- each therapy session can be costly - impact on health care system
- however this might be outweighed by the economic gain when patients become a member of society
20
Q
what is the nature/nurture debate in this topic
A
- nature - cognitive neuroscience - kuperberg found hyperactivity in the temporal and prefrontal cortex for schizophrenics shown semantically similar words
- nature - cognitive - frith - found an attention deficit - too much information is processed by the mind as internal thoughts are no longer filtered before reaching the conscious mind leading to the sensory overload. Somaia Mohamed found 94 schizophrenia patients had problems with memory attention, organisation, language supporting attention deficit theory
- nurture - behaviourist thoery if schizophrenia - reinforcement of odd behaviours leads to developing a phsycotic state
21
Q
evaluate freewill/determinism in this topic
A
- bio determinism - cognitive neuroscience - kuperberg found hyperactivity in the temporal and prefrontal cortex for schizophrenics shown semantically similar words
- freewill - cognitive -use of CBT shows freewill
- environmental determinism - behaviourist thoery if schizophrenia - reinforcement of odd behaviours leads to developing a phsycotic state
22
Q
evaluate reductionism/ holism
A
- biological reductionism - cognitive neuroscience - kuperberg found hyperactivity in the temporal and prefrontal cortex for schizophrenics shown semantically similar words
- holism - szasz is holist - individuals should be diagnosed by considering the whole person who has thoughts and feelings rather than using a list syptoms. disturbed behaviours are psychological syotoms and should be explained and treated psychologically, e.g. cbt not medicine
- environmental reductionism - behaviourist thoery if schizophrenia - reinforcement of odd behaviours leads to developing a phsycotic state
*
23
Q
evaluate ethics in this topic
A
- informed consent - cognitive neuroscience explains cognitive deficits, e.g. disorganised speech/ thoughts. pps lack insight and may be unable to consent to research e.g. kuperberg did fMRI scans - found hyperactivity in temperol and prefrontal cortex when presented with sematically similar words.
- harm - cognitive model - somaia mohammed found cognitive deficits in 94 pps newly admitted to hospital- memory attention, language, organisation and stroop. may be first time they realised this causing stress
- less harm - szasz rejects the medical model and wants more humane treatments with consent and no side effects, e.g. CBT leads to reduces relapse
24
Q
evaluate usefulness in this topic
A
- szasz - exposing politicisation and medicalisation of psychiatry - putting limits on psychiatrists power e.g. rosenhan experiment 3
- szasz - says mental illness if a myth stops people from seeking help. Leucht showed antipsychotic reduced relapse by 27%
- difficult to assess szasz for validity - theyre subjective opinions not objective empirical evidence unlike seeman D2 receptors
- behavioural model - theoretical - can explain schizophrenia but only evidence looks at patients treatment after diagnosis, not supporting the model as a cause
25
evaluate socially sensitive research in this topic
* strength - szasz view offers an interesting alternative view of mental illness as a myth over medicalisation. ss as it could stop those needing help from getting it causing suffering when medications are effective, e.g. leucht
* weakness - negative labelling - the anti psychiatrist movement promoted rosenhans study which exposed poor diagnosis and treatment. ss as it embarrassed staff
* strength - szasz may have promoted more humane treatments like CBT
26
evaluate validity in this study
* difficult to assess validity of szasz essay based on opinion not empircal evidence
* internal validity - cognitive neuroscience has empirical research - Kuperberg found increased activity in temporal and prefrontal cortex using fMRI
* behvaioural model lacks validity - rosenhans supporting evidence shos lack of positive reinforcement and negative punishment which may cause symptoms to continue but does not support operant conditioning initiated scizophrenia
27
evaluate reliability in thos topic
* fMRI scans have low test retest reliability
* somaia mohammed studied cognitve deficits which has good inter rater reliability researchers all agreed on the range of deficits
* alternative theory of CBT is reliable - Hofmann - reviewed 106 meta analysis for schizophrenia and other disorders. response rates were higher than for other treatments - this supports szasz that more humane non medical treatments should be used
28
evaluate sampling bias in this topic
* somaia mohammed = large representitive sample compared cognitive deficits in 94 schizophrenic patients and 305 normal controls. but the study is done in USA which diagnoses using DSM - cannot generalise to europe which uses ICD which recognises subtypes
* behaviouris explanation is based on research with animals - skinners rats and pigeons - reinforcements and punishments can explain simple response behaviour but it is difficult to generalise to hallucinations and delusions. rosenhans tsudy 3 looked and reinfoecement and punihsment for asking questions is only based on 8 pps
* szasz - myth of mental illness - opinion of only one man. althought he could be sen as the spokesman for the anti psychiatry movement which included rosenhans colleagues. did result in DSM being updated
29
evaluate ethnocentrism in this study
* is - the medical model assumed the causes of mental illnss are universal due to causes being biological. however alternative explanations are culturally specific, e.g. szasz says mental illness in usa in politicised meaning that how it is viewed is affectived by dominant groups in society.this guides the gov spending on mental health e.g. more spent on medication then cbt
* somaia mohammed = large representitive sample compared cognitive deficits in 94 schizophrenic patients and 305 normal controls. but the study is done in USA which diagnoses using DSM - cannot generalise to europe which uses ICD which recognises subtypes
* is not - cognitive neuroscience has a biological basis e.g. frith states that the breakdown in the septo hippocampal system explains the delusions in schizophrenia. however delusions will be impacte by local culture.
