Week 1: Defining and diagnosing mental ill-health ( Psychiatry (Branch…
Week 1: Defining and diagnosing mental ill-health
No universal rule to label abnormal behaviour
Definitions vary across cultures because social norms ke hisaab se dekha jata hai ke kya normal hai. Maybe kisi aur ke belief mein God se baat karna weird ho but Muslims ke liye its sort of okay.
Expected behaviours are normal. Like gender stereotypes.
Spirituality, help seeking, emotional expression- ye sab culture decide karta hai.
Disadvantage- every culture gets to label whoever they want in order to gain control maybe- holocaust.
We dont want to accept societal labels but it is true ke loug bohat influence hote hain by their cultures.
Yahan bhi cultural influence hai
Subjective. What is the threshold for 'rare'?
Rare can be a positive behaviour- a talent. Savant Syndrome
Behaviour is abnormal if the person is suffering and wants to stop the behaviour
Social norms ko use nei karta to define the abnormality.
sab disorders stress nei cause karte.
Not everyone is aware of the problems their behaviour is causing others. E.g dementia, autism.
This means ke uss patient ka aware hona zaroori hai ke usse koi masla hai.
Saray distress cause karne walay behaviours abnormal nei hote. Pmsing and pregnancy.
Impairment somewhere in life
Poor quality of work and relationships
Sab disorders mein disability nei hoti
Konsi disability se abnormality ho gi aur kis se nei?
Causing distress and functioning of life nei hone de rahay.
Ye sab ooper wali bullshit hai basically.
Behaviour maladaptive hota hai if it cause distress, dysfunction, deviance or danger.
Solves problems but still subjective and gender aur culture ohir bhi behaviour ko influence karta hai
Do not show up in biological tests
Inn ka reason sirf genetic type nei hota. It is also psychosocial and some complex biological thing.
Diagnosis bas symptoms dekh ke diya jata hai. Koi process nei hai.
Do not label behaviours as abnormal unless wo kisi bemari ka part hon
Branch of medicine. Mediacl model of mental illness.
R. D Laing and thomas Szasz vs Erving Goffman in 60s. They believed ke mental illness kuch nei hota. Szasz aur Laing kehte the ke ye social deviance hai. Which is why iss ka forceful treatment aik tarah ka social control hai and iss mein political abuse bhi hota hai.
Disease: Process like infection or inflamation
Illness: Subjective symptoms.. dizziness, pain.
Physical diseases: Bodily changes- structure, functions. sensation, pain. vs mental DISEASES; brain structure and function affect hota hai and it is less subjective. E.g. alzheimers. impulses. Beliefs. etc.
Psychopathology: systematic study of abnormal experience- cognition and behaviour
Phenomenology- psychic ya physical events ki study. Observation of internal experience of the individual and categorization of the resulting behaviour.
Karl Jaspers ki book thi about form of symptoms. 1913
Diagnosis- syndromal hota hai yani ke based on clusters of symptoms. Often overlap between diagnoses.
Stigma: patients are seen as weak anf jaise unn ki ghalti hai. Dangerous too.
Forceful against will. Patient ko competent enough nei samjha jata. Law also kehta hai ke aise insaan ko unn ke actions ke liye responsible hold nei kiya ja sakta. Legal Framework 1983 Mental Health Act allows this.
Issues of diagnosis
WORLD HEALTH ORGANISATION ICD SYSTEM.
Europe and Rest of the world
First to include mental illness in 1949
Current version is the OCD-10 1992: 10 groups of disorders
Okay so the 4th category is the mood (affective) disorders and iss mein manic episodes, bipolar disorder, depressive, recurrent deperssive etc aa jatay hain.
AMERICAN PSYCHIATRIC ASSOCIATION'S DSM-SYSTEM
First in 1952 and revised 5 times.
May 2103 mein last hua tha.
ICD and DSM correspond
Consensus on diagnosis so an individual with these symptoms will get the same treatment through out the world.
2 hee options hain. Ya tou disorder hai ya nei hai. Dichotomy. What about those people jo borderline hain?
Diagnosis gets treated not the individual???
Reliability ka issue hai because the patient might show different symptoms at different times.
Biological explanation in limelight and baki social or psychosocial factors are ignored.
Kuch disorders kisi theme mein nei atay.
What about people who have two disorders?
Comorbidity is having two disorders
Deciding ke disgnosis kya hai can be an issue because experts might disagree .
Diagnostic vs dimensional
The two graphs are actually nice. Aik normal distribution ka curve for the dimensional approach and a bar graph for the diagnostic approach
Mental health on a continuum.
Diagnosed loug extreme ends pe hote hain
Degree to which problems are experienced and not absence or presence.