Week 3-Classification, Diagnosis and Formulation Flashcards

Question

What is Structural Stigma?

Answer 1

-A biomedical model of mental health and diversity can create structural stigma by reducing experiences down into deficits, shaping how society thinks about difference towards negative stereotypes (Dinishak & Akhtar, 2013). -Unemployment & social disadvantage - Less likely to get jobs (Farina & Felner, 1983). Excluded from some professions & life insurance etc. -Loss of rights - Forced treatment. Exclusion from driving / jury service. -Problematic interventions – people become seen as commodities, targeted by time-intensive, costly ‘interventions’ that claim to reduce disability (Grinker, 2020). -Mass media – Negative portrays filter into societal stereotypes (Nordhal-Hansen et al., 2018). -Creates stereotype as the DSM creates expectation of what a person with that disorder “should” be like

Answer 2

Avoidance: -People want to create social distance (Gillespie-Lynch et al., 2021; Mehta & farina, 1997; Shtayermman, 2009). For autism this occurs regardless of diagnosis (Grossman, 2015) -Professionals also have internalised stereotyped conceptualisations (Raskin & Lewandowski, 2000). Dehumanisation: -Framing stigmatised people as subhuman protects the fragile idea of normality (Goffman, 1963) -Even when non-autistic people were knowledgable about autism, they did not attribute human uniqueness traits to autistic people (Cage et al., 2018) -A psychiatrist or clinician may be less prone to internalised stereotyped conceptualisations but a GP might (as vague knowledge of conditions)

Answer 3

Internalisation-Prolonged exposure to stigma can experience shame, self-hate and self-degradation Minority stress-Prolonged internalisation leads to increased stress and lower levels of wellbeing (Botha & Frost, 2020; Meyer, 2003). This can result in physical health consequences as well as further mental health consequences Concealment and camouflaging-Stignatised individuals often begin to self-monitor and conceal external behaviours that differ from social norms which may proliferate stereotyping and stigma (Goffman, 1963; Pearson & Rose, 2021).

Answer 4

-Promotes 'us' and 'them' thinking -Narrow understanding of people's problems -Does not see people as able to change -Places problem within individual rather than environment -Narrows the focus of research (it is about diagnosis rather than need, vulnerability and risk) -Can affect physical healthcare decisions

Answer 5

-Argument that DSM and ICD should be based on a dimensional model instead. Categorical models assume a definitive cut-off point (Johnstone, 2013) -Would assume everyone varies across different dimensions (e.g., anxiety and depression) But doesn't necessarily address the issues with the disease model of mental health -Johnstone (2013): DSM-5 considered how dimensional assessments might assist categorical judgement. -Kapp & Ne'eman (2020): Resulted in severity scales which made categorised more medicalised -This model makes it worse because it’s essentially made it a severity scale and acts as if people can’t move back and forth very quickly also ignoring factors such as social factors

Answer 6

-The typical population, some shared traits, diverse but not 'divergent' -Pervasive Development Disorder, too 'mild' to call autism, some argue other divergent conditions should come in here -Atypical, autism but features hard to detect or diagnostic criteria not fully met -'Asperger syndrome' or 'High Functioning Autism' -'Classic Autism' or 'Low Functioning Autism'

Answer 7

-Oversimplifies complex human experiences and underestimates situational influence -'Support needs' assessments are better assessed in a given situation and not generalised across time frames or people -Does not overlook that some people have more disability than others, but enables a more complex, individualised view. E.g., people with 'HFA' might appear to have low support needs in work but can present as having high support needs in medical situations or become non-verbal during meltdowns

Answer 8

-For neurodivergent conditions, it might be more advantageous to think of commonalities that encompass groups of diverse individuals, similar to gender (Fletcher-Watson & Happé, 2019). -"it's more like a constellation than a spectrum. It does not move along one line going from low to high, it circles in many spheres" (Hearst, 2015)

Answer 9

-It is an individual summary of difficulties based on psychological theory done by clinical psychologists. It involves the co-creation of a narrative that tries to link individual difficulties to life events, social experiences and how a person makes sense of their experiences (Johnstone, 2013) -Can be used as an alternative to psychiatric diagnosis or in conjunction with it. -Still enables professionals to see service users as being in urgent need of support for serious distress but relies on more non-medical terms and approaches.

Answer 10

-"Hearing voices or feeling paranoid are common experiences which can often be a reaction to trauma, abuse or deprivation. Calling them symptoms of mental illness, psychosis or schizophrenia is only one way of thinking about them, with advantages and disadvantages." -Essentially the way we think about them isn't necessarily the only way

Answer 11

"The experience we call depression is a form of distress. The depth of stress itself, as well as the contributing events and circumstances, can be life-changing. And even life-threatening. However, calling it an illness is only one way to think about it, with advantages and disadvantages."

Answer 12

1. Collect information that will help understand the client's difficulties and highlight areas in which change may be possible (develop a hypothesis). 2. Individual summary co-created with the person. 3. Look at what interventions might help, which results in hypothesis testing and adaptation. Formulation is a work in progress. 4. Can help to predict future outcomes and focus on a person's strengths. Service users have agency, and are not reliant on expert opinion alone. -They can also acknowledge things they can't change e.g., trauma to offer more empathy.

Answer 13

-Since DSM-IV, diagnoses can be supplemented by axes, 2 of which refer to non-medical information. -Axis 4 = psychological struggles such as employment loss, poverty and social isolation. -Axis 5 = life functioning in work, relationships and leisure to give a bigger picture. -Underutilised in DSM and ICD. -We don’t have to say person has PTSD we can look at individual traumas and piece them together -Possible to do formulation without diagnostic disorders and categorisation to create a better picture

Answer 14

-Subjective by nature and open to bias. This is not necessarily bad if implemented properly and not treated as an objective, scientific process. -If used improperly might not include co-creation and could overlook social and cultural influence. -Newer=lack of research to support use and indicate whether service users find it helpful. Impact on therapy outcomes also largely under-researched. -Not helpful for all conditions (e.g., neurodivergent conditions). -Clinicians might treat it as objective and as a scientific discipline -Clinician might create on their own

Answer 15

-Formulation holds the potential to create accessible mental health care for neurodivergent people. -Neurodivergent conditions are important socio-political identities (Botha, 2021). -Concerns of overlooking disability and interactions with physical health e.g., sleep or digestion issues (Grant & Kara, 2021; Lenroot & Yeung, 2013). -At present, diagnosis remains important for accessing support and overcoming stigma in these groups (Leedham et al., 2019)

Answer 16

Diagnosis: -Obscures social context, an individual approach overlooking relational influences, not culturally sensitive, expert-driven and removes agency, stigmatising, medical consequences and access to medical adaptations, removes personal meaning Formulation: -Can include social context if used well, can include relationships, can be culturally sensitive if used properly, usually driven by collaboration and promotes agency, non-stigmatising, no medical consequences and may be harder to access medical adaptations, centres around personal meaning

Week 3-Classification, Diagnosis and Formulation Flashcards

(40 cards)