Please discuss how “service-user groups” have contributed to the process of deinstitutionalization and efforts to improve the societal treatment of people experiencing mental illness (pg. 41-42)
- they had an impact because they drew a lot of attention to the issue
- rose awareness of what happened inside the asylums and all the inhumane treatments
- they spoke up about their experiences, advocating for humane treatments and freedom
Identify the advantages and disadvantages of institutionalization
- program works for some but not for everyone
advantages
- those with the need of care are able to get treatment for improving their mental health with professionals
- more protection for the community since those with severe symptoms may harm themselves or cause harm to themselves or cause harm to others in the community
- more structure and support for those who cannot live on their own or afford their livings
disadvantages
- they can’t meet their families often which could make them feel isolated and cause self harm
- the families may not know what treatments are occurring in the institution
- less freedom, inhumane treatments
- patients are not able to contribute or get used to the community
- can not speak up for themselves on how they were being treated
- ex. River View, people were sterilized
- racism, also have overrepresentation of Indigenous population in BC institutions, and other areas constitutes of mostly coloured people
- no support for patients after they leave the institution
explain the Psychiatric Deinstitutionalization in BC
- Riverview Hospital opened in BC in 1913
- gov. needs to reallocate funds towards community care
- they can also reduce spending from decreased police response, hospital admissions and incarceration (imprisonment for MI patients)
What went wrong in the process of riverview hospital?
- inhumane treatments
- not enough beds and housing and quality of living (patients become homeless later)
- staff unprofessional
- difficult for patients to integrate back into the community (stigma, shame, suicide - less surveillance)
- get discharged before stabilized
- not enough beds
- returned to the institutions very quickly after they were discharged
- the people who was put out into the community seeked helped to the police iwth insufficient or improper training
- police officers only have the basic deescalating training, not professional mental health training
Recommendations for the process of deinstitutionalization given the experiences related to Riverview
- properly trained staffs
- provide more fundings for better living conditions and better reallocation
- provide more freedom and activities
- correct inhumane treatments
- provide more aid/opportunities for those leaving the hospital
- have follow-ups after they leave so this increases surveillance for those thinking of suicide
- slowly integrate them back into community… a week home and a week back then gradually increase time frame, because the community may be different from what htey had previously known it to be
- group therapy, counselling, instead of giving sedative medications
- provide supportive housing and urgent response center
discuss key events that precipitated the rise of biological psychiatry (very long but kinda review)
- started as a biological aspect
- When DSM-III was introduced it revolutionized how mental disorders were diagnosed
- used drugs as a basis of the disorders
- very scientific
- white men physicians wrote this DSM so they sometimes got extra funds with it - biased
- discussion of causes of mental illness avoided and instead checklist of symptoms for diagnosis included (some effects of medications informed these checklists)
- marketing strategies - promotes all these drugs, that this drug can treat the disease, normal human behaviour seemed as a disorder
- disease mongering
- a marketing strategy shifting away from selling medications to selling the idea of particular diseases (ex. anxiety, ADHD) to consumers to then offer a solution (ex. drug)
- they started selling more drugs because it was easier to take care of patients not inside an institution
- fee for service
- Health system pressure on physicians to treat more patients in shorter amounts of time leading to higher rates of prescribing as a response to mental illness (psychotherapy was time-consuming)
- before WWII, morphine, cold medication, were consumed off label. not a good combination when all taken together. also with alcohol. people overdosed a lot
- pharmaceutical people saw this and saw a chance of profit
- Kefauver Harris Amendment - This amendment to the Federal Food, Drug, and Cosmetic Act required pharmaceutical companies to demonstrate not only that their medications were safe, but also that they were “effective.”
- considerable rise of copy-cat medications and medications marketed as “miraculous”
- biological psychiatry is that the effectiveness of revolutionary drugs like Thorazine meant that mental illness was primarily, or even entirely, a biological phenomenon—a disruption of the normal physical functioning of the brain.
- introduction and effectiveness of psycho-pharmaceuticals like Thorazine
- Labelling a medication as an “antidepressant” rather than a “mood elevator” conveys the idea that these medications fight a specific disease entity (depression) rather than more generally impacting our mood. As a consequence, we are more likely to think of depression as having an underlying basis in neurochemistry—since that is what is impacted by these medications—rather than in our lived experiences
- public policies in the 1980s in Canada, UK and US favouring smaller government and market-driven policies
- more profitable patents
- increase in the development of psycho-pharmaceuticals
Do you think that pharmaceutical marketing contributed to the medicalization of human experiences? why or why not?
- yes because they market normal human experiences as a disorder or illness so they have more patients
- for example social anxiety, you might just be a person who needs more time to get used to an environment or friend group and you dont need rugs
- even searching up your symptoms on google, it will tell you that you are dying and make you scare and more anxious
What are the dangers and benefits of medicalization?
- dangers
- the people who really need diagnosis and these drugs might have delayed or no help at all because of the increase need of doctors and these drugs
- people who dont need these drugs might be consuming them and slowly depend on them
- some medications can cause more harm then good, one drugs’ side effect could result in u having to take more drugs
- lots of side effects
- hard to get off a drug when you are on it, doctors increase dose or they say 6 months at first but then extends it
- benefits
- they get more patients which means more profit
- the people who actually need help might learn stuff from these marketing and advertisements
- raises awareness
What are the advantages and disadvantages of direct-to-consumer marketing of psycho-pharmaceuticals?
- advantages
- efficient
- patients don’t need to get a prescription, less doctor visits
- awareness
- promote their drug to a bigger audience
- disadvantages
- false advertising
- you might not need it
- its simple for cold medications or allergy medications but not for more complicated or complex illnesses or medications
- they don’t advertise the side effects and the complications
- overemphasizing the benefits and underemphasizing the risks, not a balance perspective
- medication is a cure for the mental illness and not just a side aspect like therapy
What is the prevalence of schizophrenia globally?
- occurred in about 1 percent of the population
- old data
- men and women
Why is this being debated?
- might not see it as a disorder because it is normal in their religion or culture
- hard to estimate the exact prevalence bc theres so many unclear factors
- can’t affect everyone the same who is living in different areas and social economic statuses
- there’s no biomarker or definitive indicator of schizophrenia
- diagnosis depends on practitioner’s judgement, professional training/experience, and cultural background/expectations
- course and expression of mental illness is influenced considerably by culture
- Using Western descriptions of schizophrenia may have influenced international
prevalence estimates (misdiagnosis) - Hallucinations and delusions are not necessarily objectively measurable (what is
considered a hallucination by some may not be in other cultures)
What is meant by schizophrenia being considered an “egalitarian disorder”?
- its everywhere
- Virtually every other illness is affected by some form of regionally specific factors, whether it’s the genetic makeup of the population, local toxins in the environment, or culturally conditioned diets, among other factors.
- but schizophrenia is everywhere for anyone
- everyone has an equal chance of getting it regardless of differences
- it is unlikely that schizophrenia occurs at the same rate across the world, since almost all illnesses are affected by regional factors that lead to different distributions of the illness
- BUT its not actually an egalitarian disorder
Why might it not be an egalitarian disorder?
- poor living conditions increase the risk of developing schizophrenia
- high levels of stress
Individuals diagnosed with schizophrenia disproportionately reside in lower income neighbourhoods and earn below average income
Why do you think people from poorer neighbourhoods or with lower incomes are more likely to be diagnosed with schizophrenia?
Socio-economic status may be a cause of schizophrenia
* Poor living/social conditions increase the likelihood of a person developing schizophrenia
* Conditions associated with poor neighborhoods (e.g., violence and lack of recreational
opportunities) and factors associated with low income (e.g., marital and parental conflict)
can generate stress
* Less access to healthcare
Drift hypothesis
* Argues: lower socioeconomic status is a consequence of schizophrenia
* Symptoms of schizophrenia, such as disorganized thinking, can make it more difficult for someone to maintain employment or obtain higher education. This can result in the
individual having less income
Practitioner bias
* Research evidence has demonstrated that practitioner class, racial, and cultural biases
play a role in schizophrenia diagnoses (e.g., low income individuals are more likely to be
diagnosed with schizophrenia than high income individuals)
Why do you think stigma around schizophrenia is pervasive?
- people label them as crazy
- if they dont know what schizophrenia is and that they dont know what the person is experiencing, they will just think they are psycho or on drugs, unhinged or chemically imbalanced
- people diagnosed with schizophrenia are usually violent and dangerous so people might be worried for their safety but usually they are usually victims of violence
- smth that is not as common in people like depression or anxiety so they cannot relate to it
- portrayed negatively on media
What is the impact of stigma on individuals experiencing schizophrenia?
- you cant talk about it with others because they will label u mentally ill
- scared to ask for help
- harder to get or maintain jobs
- does not receive proper treatment
- isolation because people are scared of them
- this stress could lead to episodes
- labeling theory - once labeled, they internalize the label
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