The Historical Context of Mental Health - Evaluation

Historical Views of Mental Illness

Nature/Nurture

Supports nurture side of debate with the supernatural theories. It was believed that mental illness was punishment for wrongdoings. This supports nature as it shows how individual's beliefs of reasoning for mental illness differs on individual's general beliefs

Supports nature side of the debate with the beliefs around the four humors. This was a Greek belief that four bodily fluids - blood, yellow bile, black bile, and phlegm - contribute to personality. A balanced amount would lead to a healthy person, while an imbalance of one or more of the fluids would result in mental illness

Freewill/Determinism

Supports determinism side of debate as fluids can't be controlled so excess in fluids cant be controlled either

Supports freewill side of debate as decisions to do wrong lead to mental illness and decisions are consciously made

Reductionism/Holism

Supports reductionism side of debate as mental health is reduced to four humors, but ignores other relevant factors

Supports holism side of debate as four humors give more explanation which is more holistic than supernatural

Individual/Situational

Supports individual side of debate as four humors supports as it's down to individual's imbalances

Supports situational side of debate as prehistorical believes supernatural which lacks control of situation - wrongdoings

Usefulness

Is useful as psychogenic approach led to progress in therapy. belief that mental illness was due to unconscious processes in the brain, Freud used psychotherapy and psychoanalysis to help treat - late 19th century

Is not useful as there's no scientific evidence. Supernatural explanation cannot be tested or falsified

Ethical considerations

Is ethical because of the psychogenic approach. People gave access to memories through free association, giving informed consent

Not ethical because of the supernatural theory. Exorcisms break protection of participants due to physical and mental harm caused

Socially sensitive

Is socially sensitive as determining disorder based on physiology, looking at Hippocrates, labelling

Not sensitive as, by identifying, able to find treatments

Psychology as a science

A science because of somatogenic approach. Explains mental illness using brain structure in 20th century and inherited genes which can be observed due to technology such as brain scans

Not a science because of supernatural theory. Witchcraft and demonic possession cannot be falsified

Ethnocentrism

Ethnocentric because supernatural is religiously biased, Ancient Egyptians/Chinese thought mental illness was punishment

Not ethnocentric because all historical theories include cultural factors. However four humors is less as belief is but no bias due to physical factors within body

Validity

Is valid because of humoral theory due to physiology, can be generalised to all humans

Not valid as population was only Greek for humoral theory

Reliability

Reliable as used humoral theory, everyone had them, system is replicable to all people. E.g. anyone manic had excess of yellow bile

Not reliable because of supernatural theory where abnormal behaviour was due to witchcraft can be subjective and judged differently per person

Sampling Bias

No sampling bias but there was temporal bias (bias of the time)

Defining Abnormality

Nature/Nurture

No nature argument

Supports nurture debate with deviation form social norms. Depends on social context, where culture can cause behaviour

Freewill/Determinism

Supports freewill as behaviour is down to our choice. Deviation from social norms supports this as anyone that deviates is abnormal. We choose to abide by social norms

Supports determinism as behaviour is our of our control. Statistical infrequency supports this as curve exists already so people can't choose where they sit on the curve

Individual/Situational

Supports situational with deviation from social norms as society can consider abnormal. E.g. homosexuality was abnormal until 1973, person doesn't determine abnormal but society does

Supports individual with failure to function adequately as choosing to do things is down to individual. E.g. people with schizophrenia would choose to get treatment or people with depression would be aware that they cannot get out of bed

Ethical Considerations

Is ethical because it protects from harm with deviation from ideal mental health. No one fits all criteria, therefore everyone is abnormal and no on
is stigmatised

Isn't ethical because it doesn't protect from harm with deviation from social norms. Homosexuality may have violence towards them until 1973

Socially Sensitive

Is sensitive as labelling as abnormal may lead to different treatment. Deviation from social norm e.g homosexuality

Isn't sensitive as define as abnormal leads to getting help with deviation from mental health

Psychology as a science

Is a science due to statistical infrequency with quantitative concepts

Not a science due to deviation from social norms where norm is subjective and depends on culture and time

Validity

Is valid as high in ecological validity because of failure to function adequately. Behaviours looked at, such as eating regularly, are applied to the real world

Isn't valid as low in construct validity because of deviation from social norm which only identifies behaviour outside the norm rather than mental illness

Ethnocentrism

Is ethnocentric because deviation from ideal mental health which is culturally bound in individualistic culture which relies on an absence of characteristics where personal growth ,may not apply to collectivistic cultures

Isn't ethnocentric as they aren't actually culturally bound and apply to all cultures looking at statistical infrequency where distribution curve is fixed and not based on culture

Reductionism/Holism

Is holistic due to deviation form ideal mental health which gives number of behaviours to identify mental illness

Is reductionist due to statistical infrequency where it simplifies mental illness to where people lie on a curve

Categorising mental illness

Ethnocentrism

Is ethnocentric as some systems are ethnocentric. E.g DSM created by American Psychiatrists for an American society and treatment system - capitalist industrial business

ICD less ethnocentric, created by WHO, so the UN have a say in contents so includes a more diverse range that can be applied to a wider population

Nature/Nurture

Nature: some symptoms are biological. E.g. in ICD for specific phobias, pounding heart and sweating are physically manifested symptoms

Nurture: categorisations based on how writers were brought up and society around them. Upbringing may reason why self esteem is important -> depression

Reductionism/Holism

Reductionism: lists symptoms/duration of symptoms and simplify mental disorders through this. ICD has all mood disorders grouped together. Grouping becomes reductive because symptoms overlap

Holism: DSM, between 4 and 5 it became three main sections, making it more holistic

Individual/Situational

Individual: patients describe symptoms and clinician refers to categorisation system to diagnose

Situational: diagnosis could depend on what system is used/if patient isn't comfortable may misdiagnose due to lack of symptoms told to clinician

Usefulness

Is useful because it helps clinician to diagnose and understand patient's symptoms

Not useful because systems are reductive, may become difficult for clinician to truly understand and become is like

Ethical considerations

Not ethical because systems may lead to wrong treatment which could harm patient physically and mentally

Socially sensitive research

Sensitive because systems aren't valid or reliable may lead to discrimination due to labels -> may cause people to not get jobs

Not sensitive because reviewed so often, it reduces chance of being sensitive

Freewill/Determinism

Determinism: System used to determine by where professional is. E.g. in USA, DSM used. Factors may determine diagnosis. E.g. gender

Freewill: Accuracy of clinician's diagnosis depends on patient choosing to reveal. Also from clinician's choice of questions

Psychology as a science

All classification systems are standardised. Allows same manual used every time patient comes for consultation. manual allows replicability, therefore a science. Some symptoms are objective e.g. heart palpitations. Some symptoms aren't objective, e.g. mood or someone's opinion

Validity

Is valid because symptoms allow someone to diagnose, could make it more valid. High face validity

Isn't valid because bias in diagnoses, making it not valid

Reliability

Is reliable as most diagnoses are done through standardised questionnaires

Not reliable as, as a diagnostic tool, should produce same results, but due to factors (e.g. genders) it does not. Questions not always standardised

Sampling bias

Is biased because systems limited by sample seen by psychiatrists

Isn't biased because ICD used across the world so more generalisable

Rosenhan

Sampling bias

Is biased because there were only American hospitals so not generalisable

Not biased because hospitals ranged in size, age and amount of staff so generalisable

Reliability

Is reliable because of low inter-rater reliability, only one pseudo-patient was admitted to one hospital

Not reliable because high internal reliability, replicable because all were told to say the same thing (empty, hollow, thud)

Freewill/Determinism

Freewill: Difference in how people choose to react to pseudo-patients. E.g. students spoke to 100% time and only 4% were spoken to by psychiatrists. these show psychiatrists/nurses made decision to ignore pseudo-patients

Determinism: elements of patient's behaviour that is out of their control. How pseudo-patients felt after experiment was due to treatment they received from everyone else. E.g. all pseudo-patients felt powerless and depersonalised. Pseudo-patients couldn't control how health professional acted towards them -> not their choice

Psychology as a science

Is a science because it used DSMIV and ICD10 which DSMIV devised by American psychiatrists and ICD10 by WHO across world, used by professionals, reliable

Isn't a science because it suggests psychiatric diagnosis is extremely inaccurate. All 8 patients were admitted to hospitals for 3-5 days. Systems used DSMIV and ICD10. DSMIV poor reliability

Socially sensitive research

Sensitive: patients admitted to hospital, describing sounds as empty and hollow which could cause stigma around schizophrenia which may lead to misdiagnosing and mislabelling

Not sensitive: easier to diagnose schizophrenia meaning more people get treatment

Validity

High in ecological validity- field experiment - used real hospitals, staff, patients who were unaware of study - behaviour wasn't adjusted - generalisable - behaviour representable

Low population validity - only American hospitals and only used DSM - can't be applied to elsewhere

Ethnocentrism

Not ethnocentric: aware of culture affecting findings - theories support Benedict's study "Cheers! Normality and abnormality are not universal, but is viewed as normal in one culture might not in another" - aware of social norms and may not apply universally

Ethnocentric: diagnoses of same participants were cause by use of DSM - based on social norms - lot of research to create DSM took place on white middle class Americans. Social norms are different worldwide, one country's social norms could claim abnormality, this cannot be applied for all countries

Reductionism/Holism

Reductionism: looks at insanity and diagnosing on personal events. Psychiatrists strongly biased on significant event. E.g. relationship with parents which explains giving diagnosis is down to events

Holism: psychiatrists gave diagnosis based on pseudo-patients symptoms. Claimed someone had anxiety when pacing corridor and diagnosed all pseudo-patients as schizophrenic when mentioning hearing voices. Psychiatrists diagnosed due to symptoms/behaviours rather than other factors

Psychology as a science

Science: uses quantifiable data. Study 2 staff rated admission with 10 point scale which means we are able to analyse/compare results

Not a science: some aspects may be seen as objective and not falsifiable. Patients made notes on staff. Different observations of same people -> subjective

Individual/Situational

Individual: treatment dependent on characteristics of whether their mentally ill or not . E.g. for pseudo-patients. 4% psychiatrists spoke to them but 100% of staff stopped and spoke to them. Shows behaviour depends on individual behaviour

Situational: diagnosis dependent on clinicians opinion. E.g. although pseudo-patients still diagnosed e.g. anxiety. Diagnosis procedure dependent on situational factors. Conformation bias

Usefulness

Is useful: positive practical applications. Highlights way staff interact with patients. Found mental health workers are insensitive to feelings/emotions of patients. Causes powerlessness/depersonalisation. Useful because helps improve hospital care/staff training

Not useful: not generalisable anymore. Study conducted in 1973, found patients felt powerless/depersonalised. Insensitive because change in view on how patients treated now. Old DSM version used in study

Ethical considerations

Is ethical: protects confidentiality of patients. 8 pseudo-patients went to 12 different institutions and encountered different employees/doctors. None names in study so protects participants

Not ethical: deceives participants. 12 institutions believed patients had schizophrenia with them giving symptoms of voices which deceives participants to think they had an illness

Nature/Nurture

Nature: staff members viewed some behaviours as being out of the patients control. E.g. if patient was seen as being due to their illness -> shows symptoms of behaviour are viewed as innate part of disorders

Nurture: shows diagnosis is influenced by context of environment. E.g. all showed same symptoms but got different diagnosis. Shows behaviour is viewed differently by environmental factors

Summary

Historical views

Prehistory: Supernatural explanation -> mental illness was supernatural phenomena. Abnormal behaviour due to witchcraft, religion or possession. Also believed that mental illness was punishment for wrongdoing. Treatment included exorcisms and saying prayers

Greek culture: humoral theory -> Hippocrates believed mental illness was due to imbalance of 4 humors. This was four bodily fluids - blood, yellow bile, black bile, phlegm. Imbalance in blood led to over courageousness, yellow bile led to mania, black bile led to melancholia. Treatments included emetics, laxatives, diet and exercising

Psychogenic approach: mental illness due to psychological factors -> Freud. Treatment included talking therapy, such as CBT, and dream analysis

Somatogenic approach: mental illness due to abnormal levels of neurotransmitters (biological). refer to medical model. Dominant view of 20th century. Treatment included electroconvulsive therapy, psychosurgery, psychopharmacology

Defining abnormality

Statistical infrequency: abnormality is deviation from statistically determined norm. mental illness distribution is positive skew. Most people will show one or two symptoms, rarely will people have many/all symptoms of a mental illness. Some statistically abnormal behaviour are desirable such as scoring low on Beck Depression Inventory. Some normal behaviours undesirable, common symptoms of depression can be considered normal

Deviation form social norms: what is classed as abnormal depends on culture, historical context, age, gender, and situational context. Until 1973, homosexuality considered officially abnormal and was against the law in the UK until 1967, Over 70 countries still is illegal. Distinguishes between (un)desirable behaviours socially. Questioned where social norm should lie due to cultural differences

Failure to function properly: abnormality can be determined by ability to function, e.g. washing clothes, eating regularly. Unable to do these can cause distress to self and others. Best fits with what people think is 'abnormal'. Failure to function properly also easy to diagnose. However some people, due to culture or class and can often be misread by clinicians leading to misdiagnoses of people. E.g. cross-dressing may be seen as dysfunctional behaviour to clinicians but may help cope with stress and increase self esteem for individual

Deviation from ideal mental health: physical illness is absence of physical health, Jahoda (1958) thought same of mental health. 6 categories include: high self esteem and strong sense of identity, personal growth and self actualisation, integration, autonomy, having accurate perception of reality, mastery of environment. These were very culture bound and would mean majority of people are abnormal

Categorising mental disorders

International Statistical Classification of Diseases and Related Health Problems (ICD) produced by WHO in the UK and used around the world. First edition 1893. Used by physicians, nurses, researchers, policy makers, patient organisations. Includes mental and physical disorders. ICD-10, 21 chapters, in Ch5, F30-39 are mood affective disorders, including bipolar and major depression, F20-29 are schizophrenia, schizotypal and delusional disorders

Diagnostic and Statistical Manual of Mental Disorders (DSM) used in USA. First edition 1952. Current edition includes premenstrual dysphoric disorder and DSM1 included homosexuality which was removed in DSM3. Biggest changes between DSM4 and DSM5 was removing subtypes of schizophrenia and autism. DSM5 in 3 sections: 1 introduces new style, 2 includes 20 categories of disorders, 3 provides assessment tools for specific and general disorders

Rosenhan (1973)

Study 1: participant observation. Pseudo patients pretended to be real patients and recorded behaviour in hospital. Patients called hospital and pretended to be schizophrenic, all other details were true other than names and false jobs if real jobs were in health profession. After being admitted, acted normal and said voices had gone. Showed exemplary behaviour to be released. All but one were diagnosed with schizophrenia, remained for an average of 19 days. Staff weren't suspicious but 35/118 patients knew pseudo patients weren't real. normal behaviours often interpreted as symptoms of disorders. Depersonalisation was a big issue

Study 2: Staff in psychiatric hospital told results of first study. Told that over next three months one or more pseudo patients would try and be admitted, none did. All staff rated admittance hopeful patients on a 1-10 scale, 1 or 2 being pseudo patient. 193 admitted. Pseudo patients judged 41 by at least one staff member, 23 by one psychiatrist, 19 by one psychiatrist and one other staff member. Over diagnosis - psychiatrists more likely to call healthy person sick than sick person healthy due to risk of someone's illness. Second study showed opposite

Characteristics of 3 types of disorders

Evaluation

High external and internal validity, only generalisable in USA, ethnocentric of systems used USA and UK as very western

Biological determinism, individual explanation, deception, lack of informed consent, no physical harm caused, demonic possession is not falsifiable, diagnosis of mental illness considered socially sensitive

Affective disorders - major depression

Psychotic disorders - schizophrenia

Anxiety disorders - specific phobias

Biological treatment

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