W1-T1 Conceptualisation of mental disorder

Question 1

How the conceptualisation of mental health has changed

Question 2

describe the ways mental disorder is called and why words have their weight (value-laden) ?

Answer 2

Historically (before Freud) – madness

Mental illness - clinical
mental disorder - legal/admin construct
mental health problem/mental distress – acceptable alternative (not harsh)
mental health – popular use, used by WHO

Question 3

why mental disorder synonym with legal construct?

Answer 3

used in legal acts – i.e

1983 Mental Health Act: mental disorder is any disorder or disability of the mind

The Crown Prosecution Service: uses the term ‘mentally disordered offender’ to describe
a person who has a disability or disorder of the mind and has committed, or is suspected of
committing, a criminal offence

Question 4

What is not cosidered mental disorder according to Mental Health Act: Code of Practice

Answer 4

dependence on drugs and alcohol

Question 5

what is the current law in identifying mental disorder in England & Wales

Answer 5

if 3 professional agrees that a mental disorder is present with other criteria, the person an be detained and treated against their will

Question 6

why DSM 5 is criticized

Answer 6

intellectual blind alley (too narrow)

Question 7

define mental disorder as admin construct

Answer 7

DSM 5

– Identify mental disorder
– count mental disorder
– Calculate mental disorder burden
– Assess specific services and benefits
– diagnostic function

Question 8

the image of disorder

Answer 8

uncontroversial disorder - depression (all agree depression exists)
fashionable disorder - BPD
contested disorder - schizophrenia

Question 9

mental disorder misuse

Answer 9

as an adjective – i.e. my OCD is coming, you look anorexic

inaccurate, demeaning, raise stigma

Question 10

define mental health problem according to Mental Health Foundation

Answer 10

mental health problems range from worries we all experience as part of everyday life to serious long-term conditions.

Question 11

what information does the term ‘mental health problem’ convey

Answer 11

careful about the use of language
there is spectrum of difficulties
avoids illness language

Question 12

mental health construct according to WHO

Answer 12

Mental health is defined as a state of well-being in which every individual realizes his or her own potential can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community

Question 13

downside to WHO approach to mental health

Answer 13

inclusive definition but focus on providing service to the ones with severe problems only

Question 14

define positive mental health according to NHS

Answer 14

connect - with family/community/friends
be active - find an enjoyable activity to stick to
keep learning - will gain confidence
give to others - even just a smile
be mindful - aware of the present moment, thought/feeling

Question 15

explanation of madness in ancient worlds

Answer 15

brain disorder
react to circumstance/moral weakness, failing
demonic possession

missing – spiritual domain

Question 16

define psychological construct

Answer 16

associationism (based on Locke (1659), 18th and 19th C approaches to treatment
– Madmen do not appear to have lost the faculty of
reasoning; but having joined together some ideas very wrongly, they mistake them for truths and they
err, as men do that argue right from wrong principles

psychodynamics
– extremely influential in the 20th century, particularly in the US
– remains of great cultural importance and certainly still informs psychological treatments for personality disorder

cognitive behavioural approaches
– modern-day
– ‘individuals with persecutory delusions erroneously believe that others are trying to cause them physical,
psychological, or social harm. Our psychological conceptualisation is that at the heart of persecutory
delusions are unfounded threat beliefs (freeman, 2016)

Question 17

what’s missing from psychological construct?

Answer 17

psychometric testing
assessment of cognitive functioning
structured risk assessment

–> important especially when dealing with complex phenomena

Question 18

define characteristics of mental disorder as a brain disease

Answer 18

degeneration theories – dominated the late 19th century in a harmful way – sterilisation and merciful killing (euthanasia) for people with learning disability become public policies

general paralysis of the insane (GPI) (infection) / Alzheimer’s disease – clear neuropathology.

psychopharmacological revolution (the 1950s onwards) - remains important to contemporary psychiatric services

genetics and epigenetics - new discipline - currently
focus on an enormous amount of research with potentially important therapeutic implications

imaging and functioning imaging - still largely a research tool except for investigation of dementia

Question 19

mental disorder and sociological approaches

Answer 19

begin in the late 19th century and onwards

Durkheim - suicide and linked it to the sociological construct of ‘anomie’

Goffman - ‘the total institution’ and its
effect on individuals– total institution being an asylum, but also a prison or monastery or nunnery.

Scheff - labelling theory

Goffman and Scheff have had a continuing influence on the ways we look at mental health and mental health services –

institutions bad things and deviant behaviours as the world is societally determined.
implicitly, that worldview denies reality to a disability, which is seen as a social phenomenon.

Question 20

mental disorder and society: empirical approaches

Answer 20

1. psychological stressors act as precipitants of illness
2. childhood adversity/abuse
3. immigration experience
4. family environment
5. stigma and outcome of mental disorder
6. epigenetics -gene/environment interaction

Question 21

models for mental disorder

Answer 21

the disease model
the cognitive behavioural model
the psychodynamic model
the social model

–>mental health professional synthesis these models in practice

Question 22

frank holloway personal view on mental health disorder

Answer 22

complex phenomena

simplistic explanations are likely wrong

diagnostic and formulation helpful in making sense of problems and planning intervention

no single model is satisfactory

imply a biopsychosocial approach to psychiatry