1 - Historical Context of Mental Health

Historical Views

Ancient Times
C: Supernatural forces, possessed by evil spirit, sinner
T: Trepanning the head, exorcisms, incantations, pray, mystical rituals
R: Religious leaders/healer

Middle Ages
C: Hippocrates' Imbalance of the 4 humors (black and yellow bile, phlegm and blood). Also may be witches.
T: Emetics, laxatives, purging using leeches, cupping, restricted diet, killing
R: Family and healers

17th Century
C: Evil spirits, witches, physical cause, demonic theory
T: Opium, ointments, wore astral talisman
R: Family, workhouses/ hospitals, church, asylums

18th Century
C: Innate and psychological, as well as due to the devil.
T: Confinement, mental asylums, purging, bloodletting, hot/cold water submersion, physical restraints, drugs, gyrating chair.
R: Asylums, less burder on family. However, they were run by untrained staff and abuse occurred often.
-Middle class people could pay money to watch them as entertainment.
-1774 Lunacy Act - needed 2 separate doctors to sign
-'Bedlam' hospital

19th Century
T: Reform asylums, opium, leeches, purging, rotation therapy. Focus on individuals moral and spiritual development - encouraging manual labour, sunny rooms, exercise freely (not consistent)

20th Century
T: Psychoanalysis - unconscious mind, electro-convulsive therapy (ECT), psycho-surgery e.g. lobotomies, drugs, psychopharmacology.

21st Century
T: Psychiatric hospitals, care in the community and rehabilitation. Individuals can be sectioned. Therapies such as CBT, as well as medication

Defining Abnormality

Statistical Infrequency
A persons thinking or behaviour is rare or statistically infrequent in society e.g. 2 SD - abnormal, 3 SD very rare
Strength Helps define normal statistically (cut off points). Objective therefore reliable
Weakness Fails to distinguish between desirable and undesirable behaviour e.g IQ (higher is desirable) e.g. Obesity ('normal' but undesirable) e.g. Left handed (rare but not abnormal). Some things are abnormal but frequent (e.g. depression)

Deviation from Social Norms
Set acceptable and non-acceptable behaviour everyone follows. Standards and if broken its abnormal as its considered uncomfortable and threatening
Strength Looks at people who suffer in particular culture e.g. gay people in Russia
Weakness Time specific as may have been abnormal at a particular time e.g. drinking driving wasn't considered abnormal previously. Culturally specific - Subjective (people/societies have own opinions) e.g. personal space, homosexuality.

Deviation from Ideal Mental Health
Defines whatever is normal and anything different is abnormal


6 Categories
-Capability of growth and development - being the best you can be
-Positive view of self - like oneself
-Environmental mastery - enter new situations at ease
-Independence and autonomy - function on own
-Friendships and relationships - able to remain
-Accurate perception of reality - general
Strength Individual struggling can be identified and development of mental health (goals set)
Weakness Subjective (vague and can be interpreted differently), Feasibility (impossible to achieve as abnormal thing can be frequent) and ethnocentric (focused on individualist culture, not considering collectivist societies, NOT GLOBAL)

Failure to function adequately (Maladaptiveness)
When an individual is not able to cope with every day life. Have an inhibility - e.g. to hold down a job etc
Characteristics:

  • Irrationality and incomprehensibility - no good reason why the person chooses to behave this way
  • Vividness and unconventionality - behaviour that differs substantially from the way in which you would expect people to behaviour in similar situations.
  • Suffering - most abnormal individuals report they are suffering. However, some abnormal individuals do not appear to suffer.
  • Maladapativeness - it prevents an individual from achieving major life goals, from having fulfilling relationships with others or working effectively.
  • Unpredictability and loss of control - dysfunctional behaviour is often highly unpredictable
  • Observer discomfort - Unspoken rules about our social behaviour e.g. maintain eye contact or personal space - when others break these we feel discomfort
  • Violation of moral and ideal standards - when moral standards are violated, this behaviour may be judged to be abnormal or dysfunctional

Strength consideration of how the individual feels - how they are managing every day life from their perspective. If struggling, deemed as abnormal and will receive help. It is measurable - the GAF is a scale and allows for the extent of failure to be measured. The behaviour is observable - failure to function can be observed by others (problems noticed and intervene)
Weakness Too much focus on individual - abnormal behaviours may only be a problem for surrounding people. Abnormality doesn't always stop a person from functioning. May appear fine and fit within society but may have distorted thinking. Unclear - The ability to cope with everyday life changes (e.g. in cultures), such as body clocks

Categorising Mental Health

Purpose - 3 C's
Comprehension - Understanding causes of disorders and processes in their development
Communication - It enables us to communicate with each other about the disorders which they deal with. This involves using names of categories as standard to summarise a great deal of information
Control - It refers to their treatment and prevention.

DSM V
Mental Health professionals use it (UK, USA) and is used
to find the appropriate treatment for an individual by establishing categories of symptoms. Originally made in 1952 by American Psychiatric Association

ICD 10
Made by World Health Organisation in 1992. Mental health is only in chapter 5 as also contains other diseases.

COMPARISON
S - Made by professional bodies and revised/updated regularly. They are socially sensitive and have implications like labelling. Have criteria and symptoms for diagnosis, and rely on observed self-reported symptoms
D - ICD contains all diseases, DSM focuses on mental health. DSM has a fee, whereas ICD is free. Made by different bodies. DSM is theory based, DSM no causes identified.

Advantages of Categorising
-Easier Diagnosis
-Helps patient understand whats wrong with them, and also leads to treatments
-Reliable as universal classification system
-Support/Understanding from others
-Reduce suffering, also can initiate benefits

Disadvantages for Categorising
-Labelling and prejudice
-Self-fulfilling prophecy
-Misdiagnosis and possible faking
-Financial corruption
-Misinterpreting symptoms (overlap)
-Conflicting use - different doctors
-Self-reporting issues

Key Research - Rosenhan
Aim - Investigate the reliability of diagnosis of mental illness
Study 1 - Pseudopatients were presented to 12 different hospitals in USA. Reported hearing voices and once diagnosed they showed no further symptoms. Pp's kept written record of their own experiences and those around the hospital.
Study 2 - In different hospital, staff made aware of findings. Led to believe over next 3 months it was going to happen again. Scored new patients out of 10 whether they were an actor.
Results - S1 - All pseudopatients were admitted (11 with schizophrenia, 1 manic depression - false positive). Felt depersonalisation and powerlessness. Released with label schizophrenia in remission. S2 - 10% of genuine patients judged as pseudopatient by 1 psychiatrist and staff (false negative).
Conclusion - Psychiatric diagnosis lacks reliability. Labelling people as 'insane' can change interpretations of their behaviour - "stickiness of psycho diagnostic labels".

Application - Characteristics


Anxiety Disorder: Specific Phobia
A continuous, irrational fear and anxiety feeling which is affecting daily functioning and causing physiological responses e.g. sweating. Sub types include animal, natural environment, blood-injection injury, situational, social phobia e.g. doctors, talking in public.
Symptoms of specific phobia
In presence of it and anticipating it. Try to avoid it and experience distress. Most last for at least 6 months before being diagnosed.

Affective Disorder: Major depressive disorder
Dramatic changes/extremes of mood ranging from mild to severe. Individuals may experience feelings of sadness, emptiness and irritability, in other cases mania, euphoria or rage.
Symptoms
According to DSM 5 you must be experiencing at least 5 or more of the following symptoms during the same 2 week period e.g. insomnia, fatigue, suicidal thoughts, loss of interest/pleasure, irritated

Psychotic Disorder: Schizophrenia
Abnormal thinking and perceptions - losing touch with reality. Long term mental health condition. Only diagnosed if experience 2 or more positive symptoms for a month. Continuous signs of disturbance must last about 6 months for intervention.
Symptoms - positive (addition of new behaviour e.g. Hallucinations/delusions/ disordered thinking/speech and negative (removal of normal functions e.g. emotional, poverty of speech and reduced motivation.