topic 1 - the historical context of mental health

Question 1

what were the 4 historical views of mental illness?

Answer 1

-demonic possession
-humourism
-animalism
-moral treatment

Question 2

describe demonic possession as a historical views of mental illness, and how it was treated.

Answer 2

A SUPERNATURAL EXPLANATION

-in pre modern societies, people believed evil spirits had taken over mad people and were controlling that individuals behaviour

-people could be possessed by many kinds of spirits including:
->ancestors
->gods
->animals
->victims who the
individuals wrongdoings
towards hadn’t been

-people could be taken over for a number of reasons including:
->their own cunning
->the work of an evildoer
with magical powers
->lack of faith

TREATMENT:
-some skulls of paleolithic cave dwellers have holes called trephines which appeared to have been chipped out by stone instruments
-provided and exit for demons or evil spirits trapped in the skull

Question 3

describe humourism as an explanation of mental illness.

Answer 3

A SOMATOGENIC EXPLANATION

people used to believe normal mental health depended on a delicate balance of 4 humours:
->yellow bile
->black bile
->blood
->phlegm

imbalances were believed to produce disorders

being sluggish and dull indicated an excess of phlegm

being irritable and anxious indicated an excess of yellow bile

having a changeable temperament indicated an excess of blood

being melancholic was believed to be caused by an excess of black bile, which resulted in the disorder of depression
->it was believed this
humour could be
balanced by diets,
laxatives and
bloodlettings

Question 4

describe animalism as a view of mental illness and how it was treated.

Answer 4

A SOMATOGENIC EXPLANATION

it was believed that madness resulted from animalism - the insane had lost the one thing distinguishing them from beasts (reason)

this caused their behaviour to be disordered, unruly and wild

TREATMENTS:
-it was believed that the only way to restore reason in people, was fear
-this was done by:
->chaining people to
walls
->whipping
->bleeding
->blistering
-it was believed that the insane did not have the sensitivities of human beings, but were instead similar to animals so lacked sensitivity to pain, temperature and other stimuli

Question 5

describe the moral treatment view of mental illness.

Answer 5

A PSYCHOGENIC EXPLANATION

Pinel was one of the first to believe that mental illness could be caused by psychological or social stress, congenital conditions or physiological injury

he petitioned for the removal of chains from patients to allow them to get fresh air and exercise

he also wanted to allow for more friendly patient and doctor interactions and to preserve detailed case histories for the purpose of treatment and research

the change in treatments were found to be effective at improving the condition of the patients in the asylum’s and also led to the discontinuing of bloodletting, purging and physical abuse

Question 6

what are the 4 definitions of dysfunctional behaviour proposed by Rosenhan and Seligman?

Answer 6

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

Question 7

statistical infrequency as a method of defining abnormality and issues with it.

Answer 7

any behaviours that is seen as rare (shown by a small percentage of society) are considered abnormal by nature.
for example, only 3.5% of the UK population have schizophrenia, as found by the national audit of schizophrenia

problems:
-having more rare qualities does not necessarily mean you have a disorder
-for example: highly talent sports stars do not have disorders so statistically rare does not equal a psychological disorder
-additionally, statistically more frequent disorders, such as depression (8%) should not be considered normal

Question 8

failure to function adequately as a definition of abnormality and problems with it.

Answer 8

functioning adequately was defined as:
-holding down a job
-maintaining a relationship
-interacting effectively in society
-looking after yourself

problems:
-there could be other reasons people don’t do these things such as: lack of education, having enough money to not have a job
-however not functioning adequately definitely can indicate a disorder, for example addiction

Question 9

deviation from social norms as a definition of abnormality and problems with this.

Answer 9

societal norms vary between societies and can include things like going to work, not talking to yourself and not doing drugs

failing to abide by these could cause someone to be seen as abnormal

can be due to disorders such as OCD - someone may check a door is locked excessively

PROBLEMS:
-some behaviours may be caused by other factors, such as not having a job being due to a lack of education

Question 10

deviation from ideal mental health as a definition of abnormality and issues with this.

Answer 10

ideal mental health can be defined as:
-positive self image
-growth and development
-accurate perceptions of reality
-maintaining interpersonal relationships
-adequacy in love, work and play

Rosenhan and Seligman extended this and said it was normal to display one of the following, but if showing signs of a several of these, it may indicate abnormality:
-suffering
-maladaptiveness – not fitting in with society
-unconventional behaviour
-irrationality in behaviours that others wouldn’t be able to understand
-unpredictability/loss of control
-observer discomfort due to unpredictability and irrationality

problems with this:
-criteria can be vague
-not having/having a few of these does not indicate a psychological disorder

Question 11

what is the book mainly used to categorise disorders and who published it?

Answer 11

the diagnostic and statistical manual of mental disorders (DSM-5)

published by the American Psychiatric Association in 2013

Question 12

what are 2 examples of alternative categorising manuals except DSM-5?

Answer 12

the chinese classification of mental disorders (CCMD-3)

the international classification of diseases (ICD)

Question 13

what is an internalizing disorder?

Answer 13

they are disorders characterized by depressed mood, anxiety and related physiological and cognitive symptoms

Question 14

what is an externalizing disorder?

Answer 14

comprise of disorders with prominent impulsive, disruptive conduct and substance use problems

Question 15

what are the two main ways the DSM-5 is organised?

Answer 15

lifespan order:
-it begins with diagnosis believed to reflect developmental processes that manifest early in life, such as neurodevelopmental and schizophrenia spectrum disorder
-these are followed by diagnosis that commonly manifest in adolescence and young adulthood, such as bipolar, depressive and anxiety disorders
-it ends with diagnosis relevant to adulthood and later life such as neurocognitive disorders

mental disorders are then placed into 22 categories such as:
-neurodevelopmental disorders, such as ADHD, ASD, tourettes syndrome
-anxiety disorders such as specific phobias, social phobias, panic disorder
-feeding and eating disorders, such as PICA, anorexia nervosa

Question 16

what are the 5 additional things addressed in the DSM-5?

Answer 16

gender related diagnostic issues

culture related diagnostic issues - social norms shouldn’t lead to a diagnosis

co morbidity - recognizing which disorders frequently exist together

prevalence - such as the frequency of the issue within different age groups

diagnostic criteria - such as the time frame of showing symptoms before diagnosing

Question 17

what is an affective disorder?

Answer 17

a disorder which affects the individuals mood, such as depression or mania

Question 18

what is the DSM-5 criteria for an affective disorder?

Answer 18

major depressive disorder

five or more of these symptoms must be present during the same two week period - one of the symptoms must be 1 or 2
1 - depresses mood most of the day
2 - diminished interest or pleasure in almost all activities, most of the day
3 - significant weight loss
4 - insomnia or hypersomnia
5 - fatigue or loss of energy
6 - feelings of worthlessness or excessive guilt
7 - diminished ability to think and concentrate
8 - recurrent thoughts of death, suicidal ideation, suicide attempt or plan

symptoms should not be attributed to any other cause or disorder

Question 19

what is a psychotic disorder?

Answer 19

a disorder when an individual loses touch with reality such as schizophrenia

Question 20

what is the DSM-5 criteria for a psychotic disorder?

Answer 20

schizophrenia

two or more of the following symptoms must be present in one month - one of the symptoms must be number 1,2 or 3

1. delusions
2. hallucinations
3. disorganized speech
4. catatonic or disorganized behaviour
5. negative symptoms such as diminished emotional expression, less emotional range, reduced speech fluency, may neglect themselves

number 1,2 and 3 are all positive symptoms

Question 21

what is an anxiety disorder?

Answer 21

they are strong, persistent and irrational fear of, and desire to avoid a particular object/event/situation, and this must interfere with normal everyday functioning to be classed as a phobia

encountering the phobic stimulus results in intense anxiety being experienced

people with phobias typically acknowledge their anxiety is out of proportion, but this does not reduce the fear

DSM-5 recognises 3 categories of phobias - specific phobias, social phobias and agoraphobia

Question 22

what is the DSM-5 criteria for an anxiety disorder?

Answer 22

specific phobia

-fear or anxiety about a specific object or situation
-the phobic stimulus almost always provokes immediate fear or anxiety
-the phobic stimulus is actively avoided or endured with intense fear or anxiety
-the fear and anxiety is out of proportion to the actual danger posed by the object
-the fear or anxiety is persistent, lasting six months or more
-the disturbance is not explained better by the symptoms of another disorder

Question 23

what was the aim of Rosenhan’s study?

Answer 23

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

Question 24

what was the procedure in experiment one of Rosenhan’s study?

Answer 24

1. 8 pseudopatients phones up 12 mental hospitals across 5 states on the east and west coasts of the USA - they gave false names but the rest of the details were true (except if they were in the medical profession they would not reveal this)
2. the patients would report the symptom of hearing unfamiliar, same sex voices saying ‘hollow’, ‘empty’ and ‘thud’
3. once admitted to the hospital, they would act normally with no mention of the symptoms
   they would do everything they were asked to by staff, except take medications
4. while on the ward, pseudopatients would take notes of what happened, referring to staff and other patients

Question 25

what were some qualities of the mental hospitals used in experiment 1 of Rosenhan's study?

Answer 25

11 were state or university funded and 1 was private, relying on patient fees some were old and some were new some had good staffing levels and some didn't

Question 26

who were the participants in Rosenhan's study?

Answer 26

the staff in the mental hospitals data was also collected on other patients only one hospital administrator was aware of what Rosenhan was doing

Question 27

what were the results in Rosenhan's study in terms of diagnoses and time spent in hospital?

Answer 27

each pseudopatient was released with a diagnosis of schizophrenia in remission, except one, who was diagnosed with manic depression the time spent in hospital ranged from 7 - 52 days, with a mean of 19 days

Question 28

discuss staff and other patients ability in detecting the sane in Rosenhan's study.

Answer 28

-all of the medical staff failed to notice the pseudopatients were fake -in three hospitals, 25 out of 118 patients voiced their suspicions about pseudopatients being fake by saying things such as 'you're not crazy' and 'you're a journalist' -staff may have been unlikely to notice as misdiagnosing a healthy person as sick (type 2 error) is better than misdiagnosing a sick person as healthy (type 1 error)

Question 29

discuss staff interaction with patients in the mental hospitals in Rosenhan's study.

Answer 29

-staff only tended to come out to administer medication or therapy, instruct or reprimand patients -the average amount of time spent by attendants outside of the cage (work office) was 11.3% of their shift -the number of times nurses left the cage ranged from 4-41 times, showing variation

Question 30

discuss powerlessness and depersonalisation in Rosenhan's study.

Answer 30

-patients were verbally and physically abused by staff and would stope when other staff came in, and no one would believe the patient -patients could not initiate contact with staff -patients possessions or case notes could be seen by anyone -patients were monitored during bath and toilet times and there were no doors on the toilets -staff did not care if medication was taken or not

Question 31

describe the procedure used in the comparison study in experiment one of Rosenhan's research.

Answer 31

1. in 4 hospitals, a pseudopatient approached a staff member with a request such as 'pardon me, Mr/Mrs/Dr, could you tell me when I will be presented at the staff meeting?' 2. data was also collected from Stanford University, where a young female would approach a busy faculty member and ask 6 questions, including: 'do you teach here?', 'is it difficult to get in' 3. data was also collected from a university medical centre, where a young female had six questions 4. responses to the interactions were recorded, in terms of: -moves on, head averted -makes eye contact -stops and talks

Question 32

what was the procedure in experiment 2 of Rosenhan's study?

Answer 32

a teaching and research hospital were told in the next 3 months that one or more pseudopatients would be admitted the staff were told to rate each patient on how likely they were to be a pseudopatient a ten point scale was used, with 1 and 2 indicating a high belief they were fake

Question 33

what were the results in experiment 2 of Rosenhan's study?

Answer 33

for 193 patients who were admitted: -at least one staff member rated 41 participants as highly confident they were pseudopatients -23 were rated highly confident by at least one psychiatrist and 19 by a psychiatrist plus one other member of staff in reality, no pseudopatients attempted to be admitted

Question 34

what were some wrongful interpretations of behaviour in Rosenhan's study?

Answer 34

making notes was seen as a behavioural manifestation of their disorder queuing for lunch was seen as oral acquisition