the historical context of mental health

Question 1

what is the key research in topic 1 of mental health

Answer 1

Rosenhan- being sane in insane paces

Question 2

what was the aim of the key study by Rosenhan

Answer 2

see if mental hospitals in the USA in the early 1970’s could tell the sane from the insane

Question 3

what are the historical explanations of mental illness

Answer 3

-supernatural explanation- demonic possession
-a somatogenic explanation- humourism- animalism
moral treatment

Question 4

Outline what is meant by demonic possession as a supernatural explanation of mental illnesses

Answer 4

-mental illness was believed to arise from evil spirits taking control of an individual and controlling this behaviour
-these evil spirits could take a range of forms e.g they could be the spirits of ancestors, animals, gods, heroes or victims whose wrongs had been redressed

Question 5

Outline what the treatment for demonic possession was

Answer 5

• Creating holes (trepanning) in the possessed persons skull to let the evil spirits out

Question 6

Outline what is meant by humourism

Answer 6

-claimed that the human body is made up of 4 humours
-blood
-phlegm
-yellow bile
-black bile
When there is too much or too little of any one of the four humours illness may start. This also affects mental state with these affecting the mental as follows
-too much blood causes people to be changeable and inconsistent
-too much phlegm causes people to be sluggish and dull
-too much yellow bile causes people to be irratable and aggressive
-too much black bile causes people to be moody and anxious

Restoring balance may be the only solution. This might be achieved through means as diets purgatives and bloodlettings and sexual absitence

Question 7

Outline what is meant by animalism

Answer 7

In ST marys of Bethlehem, patients were chained to the walls or kept on long leashes. First section for lunatics in a hospital was in 1756 in the USA. They were consigned to the cellar and their scalps were shaved and blistered they were bled to a point of unconciuosness. It was normal for the keeper to have a whip and use a whip
The theory of insanity
-believed that this behaviour came from animalism and that the insane had lost the capacity that dstinguished humans from beast
Because tey had lost this there behaviour was unruly and wild. The first mandate of treatment was to restore reason. To do this they used fear

Question 8

Outline what is meant by moral treatment

Answer 8

–Phillipe Pinel born near touolouse france wrote articles on metal disorders after illness of a friend
–in 1972 he was appointed as chief physician and director of Bicetre asylum, where he was able to put his ideas to practice
-He petitioned for permission to remove the chains from some of the patients as an experiment, and to allow them to exercise in open air
-When these experiments were effective he was able to change conditions at the hospital and discontinue the costumary methods of treatment (bloodtelling purging and physical abuse)
He argued for the humane treatment of patients. He believed t is due to social stressbor physiological injury

Question 9

Rosenhan and Seligman explore four different ways of defining abnormality
Outline what these are called

Answer 9

statistical infrequency
failure to function adequately
deviation from social norms
deviation from ideal mental health

Question 10

Outline what is meant by statistical infrequency

Answer 10

Any behaviour that is shown less often than the normal amount for that society can be regarded as abnormal.
Simply on the grounds that it is not the statistical norm for that society abnormal in the sense of being rare

Question 11

what are the problems with statistical infrequency

Answer 11

Many skills and behaviours may be rare but not considered abnormal
e.g high IQ

Question 12

Outline what is meant by failure to function adequately

Answer 12

An inability to live a normal life adequately such as hold down a job maintain a relationship look after onself and interact effectively in society

Question 13

Outline what the prpblems are with the failure to function adequately as a way of defining abnormality

Answer 13

What is defines as adequate?
Some people may not need a job or want a relationship does that mean that they are abnnormal

Question 14

Outline what is meant by deviation from social norms as a way of defining abnormailtiy

Answer 14

Thus us if their behaviours go against behaviours that are deemed by the society they live in as acceptable

Question 15

What are the problems with using deviation from social norm as a way of defining abnormaility

Answer 15

The social norm changes across timw
what is normal
e.g gender identity

Question 16

Outline what is meant by deviation from ideal mental health

Answer 16

-have a positive self image, experiencing growth and development having independant thoughts and actions accurate perception of reality and maintaining interpersonal relationships

Question 17

What are the problems with usnig deviations from ideal mental health as a way of defining abnormaility

Answer 17

-who defines ideal and what it is

Question 18

Outline what the DSM is as a way of categorisng mental disorders

Answer 18

-diagnostic and statistic manual
-developed by american psychiatric association, currently on version 5. It is majnly used within the USA

Question 19

Outline what are some of the noteworthy ways that the DSM categorises mental illness

Answer 19

-places them in ‘lifespan’ order, in accordance with when in a persons life the disorders are most likely to occur.

The dysfunctional behaviours are organised into 22 categories
e.g
-obsessive compulsive and related disorders
-feeding and eating disorders
-sleep wake disorders

Question 20

Outline what the DSM 5 includes about each disorder

Answer 20

-Diagnostic criteria (specifies how many of which symptoms have to be shown for what length of time to reach a diagnosis)
-Gender related diagnostic issues (e.g no gender difference regarding hoarding disorder)
-Culture related diagnostic issues (what is diagnosed as pica in the DSM 5 is a spiritually valued practice among certainnn peoples arond the world

Question 21

Outline how defining abnormality can be considered as ethnocentric

Answer 21

-Different cultures have different social norms (i.e views on gender identities) as such what is abnormal in one culture may not be abnormal in another culture

Question 22

Outline how categorising disorders can be considered as ethnocentric

Answer 22

The DSM-5 is produced by the american psychiatric association. However it includes explicit atempts to include ‘culture related diagnostic issues’

Question 23

Outline how defining abnormality can be considered as useful

Answer 23

-A bit too wide ranging to be of practical use and includes things (e.g genius) as being dysfunctional
However it could be useful as a first way of categorisng these disorders

Question 24

Outline how categorisng disorders can be considered as useful

Answer 24

The DSM-5 is used by clinical psychologists to hel them diagnose disorders, this opens the door to treatments

Question 25

Outline how defining abnormality can be considered as reliable

Answer 25

There is no agreement about how to define abnormality (as evidences by Rosenhan exploring 4 possible ways)

Question 26

Outline how categorisng disorders can be considered reliable

Answer 26

Having lists of symptoms for each disorder (includes how many need to be shown and how long for) should help consistency in clinicians

Question 27

Outline how defining abnormality can be considered as valid

Answer 27

Counts things as abnormal that arent -e.g high iq or high level of sporting ability is rare does this make them abnormal -childrne dont hold down jobs or look after themselves

Question 28

Outline how categorising disorders can be considered valid

Answer 28

-diagnosis often rely on self reported systems this can be misdiagnosis (overlap of symptims)

Question 29

Outline what the example of an affective disorder is used

Answer 29

depression

Question 30

Outline what the example for a psychotic disorder is

Answer 30

schizophrenia

Question 31

Outline the charecteristics of the affective disorder DEPRESSION

Answer 31

-the charecteristics of a major depressive overload according to the DSM-5 are as follows: five or more of the following symptoms have been present during the same 2 week periodrly every single day , at least one symptom is either depressed mood or loss of interest or pleasure 1)depressed mood most of the day, nearly every day 2)markedly diminished interest or pleasure in all activities most of the day nearly every single day -fatigue or loss of energy nearly every day -feelings of worthlessness or excessive guilt -recurrent thoughts of death or suicide The symptoms should not be attributable to any other cause and must cayuse clinically significant distress or impairement of functioning

Question 32

Outline the example of a psychotic disorder

Answer 32

Schizophrenia

Question 33

Outline the charecteristics f the psychotic disorder Schizophrenia

Answer 33

-Schizophrenia is a psychotic disorder that typically emerges in late teens and mid 30's. For diagnosis 2 or more of the following must be presnt over a 1 month period 1)delusions (e.g prosecution of self importance) 2)hallucinations (often auditory may be visual) 3) disorganised speech (incoherence or 'word salad' 4)grossly disorganised (statue like behaviour) negative symptoms include : lack of expression/ low motivation positive can be hallucinations / delusions strong evidence of a genetic predisposition

Question 34

Outline what the anxiety disorder is

Answer 34

a phobia

Question 35

Outline what the charecteristics of the anxiety disorde phobia are define what a phobia is

Answer 35

_ A phobia is a strong persistant and irrational fear of and desire to avoid a particular object actvuty or situation. The anxiety is out of proportion to the acual danger posed by the phobic stimulus.

Question 36

what are three types of phobias

Answer 36

Specific phobia- extreme phobia for a specific object or situation e.g spiders and heights Agaraphobia- fear of open spaces, but it typically involves the fear of being in a situation where escape may be difficukt or help unavailable Social phobia- intense and excessive fear of being in a situation where one is exposed to possible scrutiny by others. This includes the fear of public speaking, the fear of interacting with an authority figure

Question 37

What are the strengths that the patient must be displaying the listed charecteristics of the condition

Answer 37

-clear criteria should lead to a more reliable and accurate diagnosis -DSM could be seen as a more scientific way of classifiying disorders -Diagnnostic criteria take account of the fact that there may be other causes for the symptoms

Question 38

What are the weaknesses that the patient must be displaying the listed charecteristics of the condition

Answer 38

-issues in terms of how the doctor assess the patient through observing the behaviour and relyin on self report (bias or subjective) -people may not show all symptoms or havent shown for long enough to recieve a diagnosis -people may show symptoms or more than one illness and so it is difficukt to know to make an diagnosis due to (overlap)

Question 39

Outline the sample of study 1 in the key research by Rosenhan

Answer 39

-8 sane people phoned up for an appointment at 12 different mental hospitals -When they arrived at admissions they all reported the same symptom of (of hearing unfamiliar voices of the same sex saying 'empty' 'hollow' and 'thud' they all gave false names -Once admitted they stopped simulating any symptoms and took part in regular ward activities, all the time taking notes about wardstaffand patients

Question 40

What were the conclusions from rosenhans study on sane people

Answer 40

-mental hospitals in the USA in the early 1970'swere not good at makig valid diagnosis (couldn't identify sane people in study 1 an couldn't identify insane people in study 2) -mental hospitals in the USA in the early 1970s were not very good at making reliable diagnosis (as in study 1 the exact same symptoms lead to diagnosis of different conditions) -mental hospitals in the USA and the early 1970s tended to view all behavious as reflecting the diagnosis a patient is given -patients in mental hospitals in the USA in the early 1970s were often treated with profound disrespect

Question 41

Outline what was being tested by study 1 in Rosenhans key research

Answer 41

-In four of the hospitals, the pseudopatients approached a staff member with a simple polite request such as 'pardon me Dr could you tell me when i will be presented at the staff meeting' -The test involved pseudopatients recording how doctors responded to this request: -move on with head and avert -made eye contact -paused and chatted -stopped and talked - A comparison study was also done at stanford university where they asked busy professor 6 questions -Another comparison study was carried out at a university medical centre

Question 42

Outline the qualitative findings from Rosenhans study 1

Answer 42

- On all occasions the pseudopatient were admitted, one with a diagnosis of manic depression and all other occasions with schizophrenia -They remained in hospitals for 7-52 days an average (19 days) -When they were discharged, it was with a diagnosis of schizophrenia 'in remission' - although their sanity was not detected by the staff, 35 of 118 patients voiced their suspicions -While in hospital their normal behaviours were misinterpreted -patients records could be seen by anyone -they also saw some of the ward orderlies beung brutal ti patients but stopping as soon as another member of staff was there -attendents spent 11.3% of their shifts outside the cage (the ward office) -

Question 43

what phrases did patients say in study 1 when they thought the pseudopatients werent actually patients

Answer 43

-your not crazy -youre a journalist or a professor -your checking up o the hospital

Question 44

How were the normal behaviours of pseudopatients misinterpreted by the staff

Answer 44

-note taking was seen as a symptom of schizophrenia -a group of patients queuing up for lunch was described by a psychiatrist as displaying oral acquasitive behaviour that may be expected from schizophrenics

Question 45

Outline the total time psychologists spent with a patient a day

Answer 45

a day was on average 6.8 minutes a day

Question 46

Outline the results from psychiatric hospitals on psychiatrists

Answer 46

psychiatrists move on with head averted 71% make eye contact 23% stop and talk 4% 2%pause and chat repeats 185

Question 47

Outline the results from rosenhan on nurses and attendants

Answer 47

moves on with head averted 88% makes eye contact 10% pause and chates 2% stop and talk 0.5% repeats 1283

Question 48

Outline study 2 by Rosenhan

Answer 48

- A teaching and research hospital was aware of the first study and was informed that over the next 3 months one or more pseudopatients would attempt to be admitted to the hospital -Each member of staff was asked to rate on a 10 point scale each new patient as to the likelihood of their being a pseudopatient (but to treat everyone as normal so that no one would miss out on treatment if needed) -in practice 0 pseudopatients attempted to be admitted during this period so the staff were just rating the regular intake

Question 49

Outline the results from Rosenhans study 2

Answer 49

Number of patients judged-193 number of patients confidently judged as pseudopatients by at least one staff member =41 number of patients confidently judged as pseudopatients by at least one psychiatrist =23 number of patients confidently judged as pseudopatients by one psychiatrist and one other staff member =19