Topic 1: Historical Context of Mental Illness

Question 1

Who can diagnose disorders?

Answer 1

Psychiatrists or psychologists.

Question 2

Define demonic possession.

Answer 2

The belief that everyone and everything has a soul, and that evil spirits had taken possession of an individual and controlled their behaviour.

Question 3

What did Hippocrates think madness resulted from?

Answer 3

An imbalance of the four humours and could therefore be cured by balancing these four humours: blood, phlegm, yellow bile, black bile.

Question 4

What was the main way of treating the mentally ill in the 18th century?

Answer 4

To treat them like animals.

Question 5

Explain why people believed that madness resulted from animalism.

Answer 5

The person had lost the capacity of ‘reason’, which is the one thing they felt distinguishes humans from beasts.

Question 6

Regarding animalism, how would the mentally ill be treated?

Answer 6

The 1st part of the treatment was to restore reason, and it was believed that fear was the emotion that was best suited to restoring disordered minds.
- They would be kept locked up, chained and possibly whipped.
- Other treatments such as bleeding, blistering, making them sick and drugs were given with the belief that the insane didn’t have the sensitivities of human beings – but like animals lack of sensitivity to pain, temperature and other stimuli.

Question 7

What did Philippe Pinel (1700s) believe?

Answer 7

Mental disorders can be caused by psychological or social stress.

Question 8

What did Philippe Pinel (1700s) argue?

Answer 8

For the humane treatment of patients and the maintenance of detailed case histories.

Question 9

What did Philippe Pinel’s (1700s) approach reject?

Answer 9

The concept of demonic possession.

Question 10

What did Philippe Pinel (1700s) petition for?

Answer 10

To remove chains from patients and allow them to exercise in the open air, he also worked on discontinuing practices such as bloodletting and purging.

Question 11

Describe how abnormality is defined regarding statistical information.

Answer 11

Behaviour is abnormal if it falls outside the norm.

Question 12

What is the problem with using statistical information to define abnormality?

Answer 12

Just because something is rare doesn’t mean that it equates with a psychological disorder.

Question 13

Describe how abnormality is defined regarding failure to function adequately.

Answer 13

• In society, we have expectations about how people should live their lives.
• When someone is unable to meet these obligations and cannot live a ‘normal’ life, they are seen as not functioning adequately.
• Usually, these people are unaware of themselves.

Question 14

What is the problem with using ‘failure to function adequately’ to define abnormality?

Answer 14

Subjective, as some people may not align with societal norms but it doesn’t necessarily mean they are unwell.

Question 15

Describe how abnormality is defined regarding deviation from social norms.

Answer 15

Social norms are the expected/approved ways of living, and when they’re defied, people tend to be surprised.

Question 16

What is the problem with using ‘deviation from social norms’ to define abnormality?

Answer 16

Just because someone doesn’t follow social norms does not mean that they have psychological problems.

Question 17

Describe how abnormality is defined regarding deviation from ideal mental health: state 4 aspects of ideal mental health.

Answer 17

• Positive about yourself
• Acting independently
• Having an accurate perception of reality
• Positive social interactions

Question 18

Describe how abnormality is defined regarding deviation from ideal mental health: state 5 aspects of signs of abnormalities in mental health.

Answer 18

• Violation of moral standards
• Irrational behaviours
• Unpredictability
• Unconventional behaviour
• Maladaptiveness

Question 19

What is the problem with using ‘deviation from ideal mental health’ to define abnormality?

Answer 19

• Difficult to access
• Just because people show these traits doesn’t mean they have a psychological disorder

Question 20

State the 5 additional categories that the DSM-5 includes information about.

Answer 20

1. Gender related diagnosis issues
2. Culture-related diagnosis issues
3. Co-morbidity (which disorders frequently occur together)
4. Prevalence (frequency between age groups)
5. Diagnosis criteria

Question 21

What does DSM-5 attempt to record?

Answer 21

All disorders, both physical and mental.

Question 22

How is DSM-5 organised?

Answer 22

On developmental and lifespan considerations.

Question 23

How many categories are in DSM-5? Give some examples.

Answer 23

22 categories of mental disorder, e.g. neurodevelopmental disorders

Question 24

State the clusters disorders in DSM-5. Internalising disorders (depression/anxiety)

Question 25

Evaluate validity regarding categorising disorders.

Answer 25

- Psychiatric disorder categorisation relies on potentially biased self-report data, impacting validity. - Clinician bias exists, demonstrated by differential diagnoses based on patient gender (Ford & Widiger study).

Question 26

Evaluate validity regarding defining abnormality.

Answer 26

If the way of defining abnormality is very subjective, e.g. deviation from social norms

Question 27

Evaluate reliability regarding defining abnormality.

Answer 27

- Some of the methods are likely to be more consistent than others. - Deviation from social norms is least likely to lead to consistency, and statistical infrequency is most reliable, as psychiatrists are dealing with numbers which are more subjective and reliable.

Question 28

Evaluate reliability regarding categorising disorders.

Answer 28

Despite there being manuals to categorise disorders, there could still be disagreements between psychiatrists, especially as diagnosis relies on self-report → inconsistency in diagnosis.

Question 29

Evaluate the usefulness of defining abnormality.

Answer 29

- Useful as long as ways of defining are accurate, so treatment can be given. - Defining is subjective, so less useful as people may be considered abnormal when they are not.

Question 30

Evaluate the usefulness of categorising disorders.

Answer 30

- Using the DSM/ICD is useful as psychiatrists can prescribe treatment for the condition. - However, it gives individuals labels which could have a negative impact.

Question 31

Evaluate ethnocentrism regarding defining abnormality.

Answer 31

What is 'abnormal' in one culture may be 'normal' in another.

Question 32

Evaluate ethnocentrism regarding categorising disorders.

Answer 32

- Some disorders are not recognised in some cultures. - Different manuals in different cultures may include conditions that are culture-specific.

Question 33

Rosenhan: What was the aim of the study?

Answer 33

To see is mental hospital in the USA in the early 1970s could tell the sane from the insane.

Question 34

Rosenhan: Study 1: Describe the sample and how many hospitals they called for an appointment.

Answer 34

- 8 sane people - 12 different mental hospitals

Question 35

Rosenhan: Study 1: What did the participants say to get administered?

Answer 35

That they hear an unfamiliar voice of the same sex saying 'empty', 'hollow' and 'thud'. They all gave fake names.

Question 36

Rosenhan: Study 1: What did participants stop doing once they were admitted, and what did they make notes on?

Answer 36

Stopped simulating any symptoms and took part in regular ward activities, all the time making notes for the ward staff and patients.

Question 37

Rosenhan: Study 1: Describe what the pseudopatients were diagnosed with.

Answer 37

One patient was diagnosed with manic-depressive psychosis, and all the others were diagnosed with schizophrenia.

Question 38

Rosenhan: Study 1: How long did the participants remain in the hospital?

Answer 38

7 to 52 days (average of 19 days)

Question 39

Rosenhan: Study 1: Once participants were discharged, what were they diagnosed with?

Answer 39

Schizophrenia 'in remission'.

Question 40

Rosenhan: Study 1: How many patients voiced their suspicions? Give qualitative examples of what they said.

Answer 40

35 out of 118 - "You're not crazy" - "You're a journalist or a professor" - "You're checking up on the hospital"

Question 41

Rosenhan: Study 1: Give an example of how the participant's normal behaviours were misinterpreted as a symptom of their 'disorder'.

Answer 41

A group of patients queuing up early for lunch was described as displaying oral acquisitive behaviour which is prominent in those with schizophrenia.

Question 42

Rosenhan: Study 1: Who could patient records be seen by and how did some ward staff acts towards patients when other staff weren't around?

Answer 42

Anyone could see patient records. Some ward staff were brutal to patients in full view of other patients, but stopped when another member of staff approached.

Question 43

Rosenhan: Study 1: What was the percentage of time that attendants spent outside of 'the cage' (ward office)?

Answer 43

11.3%

Question 44

Rosenhan: Study 1: What was the total time a patient spent with psychologists per day on average?

Answer 44

6.8 minutes.

Question 45

Rosenhan: Study 1 The Experiment: What would pseudopatients in 4 of the hospitals approach a staff member and ask?

Answer 45

"Pardon me, Mr/Mrs/Dr X, could you tell me when I will be presented at the staff meeting?"

Question 46

Rosenhan: Study 1 The Experiment: What was recorded regarding the staff members' reaction to the polite request?

Answer 46

Whether they moved on with their head averted, made eye contact, paused and chatted, or stopped and talked.

Question 47

Rosenhan: Study 1 The Experiment: Describe the comparison study that was carried out at Stanford University.

Answer 47

A young female would approach a member of staff who looked busy and ask them 6 questions, including "Pardon me, could you direct me to Enciena Hall?" and "How does one apply for admission to the college?"

Question 48

Rosenhan: Study 1 The Experiment: Describe the comparison study that was carried out at a University Research Centre.

Answer 48

A young female said (amongst 6 questions that she had to ask) either "I'm looking for a psychiatrist" or "I'm looking for an internist".

Question 49

Rosenhan: Study 2: What was a teaching and research hospital informed of?

Answer 49

During the next 3 months, 1+ pseudopatients would attempt to be admitted into the hospital.

Question 50

Rosenhan: Study 2: What was each member of staff asked to do?

Answer 50

Rate on a 10-point scale each new patient as to the likelihood of them being a pseudopatient (but treat everyone as a real patient so that no one would miss out on treatment that they needed).

Question 51

Rosenhan: Study 2: How many pseudopatients attempted to be admitted?

Answer 51

0

Question 52

Rosenhan: Conclusions: What were mental hospitals in the USA in the early 1970s not good at?

Answer 52

Making accurate and reliable diagnoses.

Question 53

Rosenhan: Conclusions: What did mental hospitals in the USA in the early 1970s tend to view all behaviours of patients as?

Answer 53

As reflecting their diagnosis (stickiness of psychodiagnostic labels).

Question 54

Comment on Rosenhan's study about ethnocentrism.

Answer 54

- Only conducted in the USA but across multiple states and different types of hospitals (private/public & old/new). - Likely, patients in the 1970s in other cultures were treated similarly, as mental illnesses were not given the same attention as physical illnesses.

Question 55

Comment on Rosenhan's study about ethical considerations.

Answer 55

- Medical staff/patients didn't consent to observation. - Not protected as they were judged/felt bad. - Deception (didn't know of the study). - Hospitals didn't consent/agree to access 'fake' patients. - No named recorded - maintained confidentiality.

Question 56

Comment on Rosenhan's study about validity.

Answer 56

→ No demand characteristics. → High ecological validity. → Low ecological validity as it is unusual for fake patients to be admitted based on hearing 3 words. → Quantitative and qualitative data (increase validity). → The diagnosis isn't accurate.

Question 57

Comment on Rosenhan's study about reliability.

Answer 57

→ Multiple hospitals with similar results. → Large sample. → Same controls. → Time locked (can't be repeated). → The diagnosis was not consistent.

Question 58

Comment on Rosenhan's study about the usefulness of research.

Answer 58

→ Allows changes to be made in psychiatric hospitals/change of treatment of patients, and diagnosis in DSM. → People were shocked by the poor treatment, so conditions had to change.

Question 59

Comment on Rosenhan's study about individual/situational explanations.

Answer 59

Situational: staffing levels and hospital procedures. Individual: differences in how symptoms are experienced and has people cope with them.

Question 60

State 5 symptoms of an affective disorder: Depression.

Answer 60

→ Depressed mood most of the day. → Diminished please/interest in activities all day. → Body weight loss of more than 5% (not due to diet). → Insomnia or excessive sleep. → Restlessness/less activity.

Question 61

State 5 symptoms of a psychotic disorder: Schizophrenia.

Answer 61

→ Delusions. → Hallucinations. → Disorganised speech. → Grossly disorganised/catatonic behaviour. → Negative symptoms.

Question 62

What are negative symptoms?

Answer 62

The removal/loss of normal function.

Question 63

State 5 situations that may cause fear in an anxiety disorder: Phobias.

Answer 63

→ Using public transport → Being in open spaces → Being in enclosed spaces → Standing in a line/crowd → Being outside of the home