Historical Context of Mental Health

Background

Although the medical model is the most common explanation of mental illness this hasn't always been the case. Before modern medicine, unusual ways of thinking and behaving was accounted for and treated in many different ways. (Look at mental health history coggle to see the development from Ancient times through to 21st Century).

Defining abnormality

Abnormality (atypical) term used by psychologists to describe range of thinking and behaviours. (Look at defining abnormality coggle for ways to define abnormality)

Categorising mental disorders

Purpose of medical/psychiatric classification

  1. Communication: classification enables users to communicate with each other about disorders they deal with. Involving categories standard shorthand ways of summarising info.
  2. Control: psychiatric disorders primarily refers to treatment and prevention. Ultimate purpose of classification.
  3. Comprehension: Classification should provide comprehension understanding of causes of psychiatric disorders and processes involved in development and maintenance.

DSM-V handbook of health professionals in US, UK and parts of the world regard as authority on mental disorder diagnosis. 5th edition, descriptions, symptoms and other criteria allowing reliable diagnoses of 157 disorders. Process of completing latest edition involved 160 international researchers. By looking at old and new research disorders removed or changed. Reliability increased by more precise definitions of each disorder. (Refer to DSM-V and ICD-10 coggle for more info).

ICD-10 World Health Organisation used in many countries in the world diagnosing physical and mental conditions. Chapter V is based on mental and behavioural disorders, regularly updated to fit with society. ICD produced by global health agency constitutional public health mission. In ICD each disorder has a description of main features and any associated. Each disorder has a code (100 categories), some relating to childhood and developmental disorders, or eating disorders, applicable to children and adults. (Refer to DSM-V and ICD-10 coggle for more info).

Key Research: Rosenhan (1973) Being sane in insane places.

Aims: To extend efforts of previous researchers submitting themselves to psychiatric hospitalisation but commonly remained in hospitals for short periods of time, with knowledge of hospital staff. Test diagnostic system (DSM IV) see if valid and reliable. Him and 7 other individuals got themselves admitted to psychiatric hospitals, to see what it was like.

STUDY 1

Variables: IV: Reporting of symptoms.
DVs: Diagnosing/patient-staff interactions/length of stay.

Sample: Opportunity: Staff and patients at 12 psychiatric hospitals in USA.

Procedure: Field experiment, covert participant observation and self-report. 8 sane people, 3 women, 5 men 'pseudopatients'. Rosenhan was one. Psychology graduate, 3 psychologists, paediatrician, psychiatrist, painter and housewife. Made appointments at 12 different hospitals saying they heard voices saying "empty", "hollow", "thud". All gave false names and occupations. Once admitted behaved normally, said voices stopped. All made notes once admitted. Took part in ward activities, spoke and interacted with patients. Hid and flushed medication. If asked how felt say "fine and no longer experiencing symptoms". Had to convince staff they were sane to get out. In 4 hospitals approached staff and asked when they could leave. Interactions compared to control group between female researcher and staff members (directions). Pseudopatients recorded qualitative and quantitative data.

Findings: Doctors diagnosed sane researchers as having a mental illness, false positive diagnosis/ type 2 error.
Pseudopatients all admitted.
11 given schizophrenia, 1 diagnosed with manic depression. Discharged with 'schizophrenia in remission'.
7-52 days in hospital (average 19 days).
Genuine patients did detect pseudopatients (35/118 in 3 hospitals).
Saw no change in behaviour as a result of being hospitalised.
2,100 pills given to pseudopatients.
Staff kept away from patients. 11.5 times per shift, late afternoon and night nurses on average 9.4 times per shift. Doctors even more remote maintain greatest distance.

Behaviour staff labelled as abnormal: 1. Writing notes in 'diary': interpreted as behavioural manifestation of being psychologically disturbed.

  1. Queueing early for lunch: found sitting outside cafeteria half an hour before lunchtime. Oral acquisitive.
  2. Pacing around the ward: pacing corridors-boredom, nurse asked if nervous.

Pseudopatients felt powerless and depersonalised, personal privacy at a minimum. Nurse unbuttoned her uniform in front of viewing men. Pseudopatients ignored as didn't exist/staff moved on.

STUDY 2

Variables: IV: Expect Pseudopatients. DV: Whether staff identified any Pseudopatients.

Sample: Opportunity, staff at one psychiatric hospital in the USA.

Procedure: Pseudo patients attempt to be admitted to hospital in next 3 months. 193 patients admitted new pseudo patients on 1 to 10. Rosenhan didn't send any. Quantitative data was collected.

Findings: 3 month period, 193 patients admitted. 41 (genuine) patients judged as pseudo patients by at least one member of staff.
23 (genuine) patients judged pseudo-patients by at least one psychiatrist.
19 (genuine) patients judged pseudo-patients by psychiatrist & another member of staff.
No pseudo patients sent by Rosenhan.
Mentally ill judged to be sane. False negative diagnosis or type 1 error.

Conclusions: Psychiatrists can't reliably tell difference between sane and insane. More inclined to call healthy person sick than sick person healthy as potentially dangerous to release sick person without treatment. Err on side of caution. Very subjective. All behaviour is interpreted. Sticky label. Interactions with hospital staff brief. Insensitive to feelings and emotions of psychiatric patients. Feel powerless and depersonalised.

Application

Characteristics of an effective disorder: Depression Individuals experience feelings of sadness, emptiness, irritability, mania, euphoria or rage. 'Highs and lows' everyday life and damage impact on capacity to function. It occurs in 1/5 of the population. Several types.

Symptoms of major depressive disorder: 5 or more following symptoms been present during same 2-week period and represent change from previous functioning; at least one symptoms either (1) depressed mood or (2) loss of interest or pleasure.

  1. Significant weight/appetite loss or gain.
  2. Insomnia or hypersomnia.
  3. Inability to relax/sit still.
  4. Fatigue/loss of energy.
  5. Excessive feelings of worthlessness/guilt.
  6. Loss of concentration/ability to think.
  7. Thoughts of death, suicidal ideation, suicide attempt/plan.

Characteristics of a psychotic disorder: Schizophrenia
Psychotic disorders cause abnormal thinking and perceptions. Psychosis causes a loss of sense of reality. 2 main symptoms are delusions and hallucinations. Schizophrenia is an example.

Delusions- false beliefs, hindering a person's ability to function. E.g. believing people are trying to hurt you but have no evidence or believing you're someone else, i.e. Jesus.

Hallucinations- false perceptions, visual, auditory, olfactory, tactile or taste. Auditory are most common.

Symptoms and characteristics of schizophrenia: Symptoms divided into positive and negative, positive are distortion or excess of normal functions. Negative are reduction/loss of normal functions. Symptoms need to be persistent, requires duration of 2 more positive symptoms for a month at least. Symptoms must last for 6 months, with 1 month of positive, social/occupational deterioration. 1/100 people diagnosed in their lifetime, men more likely aged late teens/early 20's.

Positive symptoms:

  1. Hallucinations- perceptual disturbances. Auditory hallucination, may talk about them, warn them, or give out orders.
  2. Delusions- disturbances of though involving false beliefs (types of delusions: paranoid delusions, delusions of grandeur, delusions of control).
  3. Disordered thinking and speech- unable to concentrate/sort things into logical sequences, believe others can hear their thoughts.

Negative Symptoms:

  1. Affective (emotional)- reduction in range and intensity of emotional expression. Unexpected emotions.
  2. Poverty of speech- reduction in fluency and willingness to talk to others.
  3. Reduced motivation- sufferer spend many days doing nothing, neglect themselves, loss of interest in life.

Characteristics of an anxiety disorder: specific phobia Excessive and persistent fear anxiety. Can be either mild or severe. Several conditions with anxiety as a main symptom and specific phobia is one. Most common type. 6% of people in UK suffer. Can affect anyone, no matter age, sex and social background. Phobia is extreme and irrational fear producing physiological responses, e.g. sweating, shaking, etc. For fears to be classed as specific phobias must impact everyday life.

5 sub-types: Animal, natural environment, blood-injection-injury, situational and other.

Symptoms of a specific phobia: Experiences significant and persistent fear when in presence of, anticipating presence, object of fear, can be object, place or situation.

  1. Patient experiences strong, persistent fear excessive/unreasonable. Cued by object/situation present/anticipated.
  2. Phobia stimulus immediately provokes anxiety, e.g. panic attack/anxiety symptoms.
  3. Fear unreasonable/out of proportion, patients aware.
  4. Phobic situation avoided/endured with intense anxiety/distress.
  5. Avoidance, anxious anticipation/distress in feared situation impacts normal routine, occupational functioning, social activities/relationships, marked distress about having phobia.