Mental Illness notes

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Topic

Background

Key research

Application

The historical context

of mental health

Historical views of

mental illness

Defining abnormality

Categorising mental

disorders

Rosenhan (1973)

On being sane in insane

places.

Characteristics of an

affective disorder, a

psychotic disorder and

an anxiety disorder.

The medical model

The biochemical

explanation of mental

illness

The genetic explanation

of mental illness

Brain abnormality as an

explanation of mental

illness

Gottesman et al. (2010)

Disorders in offspring

with two psychiatrically

ill parents.

Biological treatment of

one specific disorder.

Alternatives to the

medical model

The behaviourist

explanation of mental

illness

The cognitive explanation

of mental illness

One from:

the humanistic

explana on of mental

illness

the psychodynamic

explana on of mental

illness

the cognitive

neuroscience explana on

of mental illness.

Szasz (2011)

The myth of mental

illness: 50 years later.

Non-biological treatment

of one specific disorder.

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Historical Views

Prehistoric times

Trepanning = surgical procedure involving piercing the skull to create a hole where evil spirits were supposed to be released. Used for treatment of seizures, migraines and mental illnesses for thousands of years across many cultures

Middle Ages

In Ancient Greece, Hippocrates was accredited with developing the first systems of clarifying mental illnesses. Proposed that disorders occurred due to an imbalance of fluids or 'humours' in the body (e.g. blood, phlegm, yellow bile)

Until the 19th century

People with mental illnesses were mostly held in workhouses, prisons and 'madhouses' which were highly unsuitable as they ran for a profit rather than for the therapeutic benefit of residents. The Madhouse Act of 1774 introduced licensing and inspections of madhouses to ensure care of patients.

Defining Abnormality

Term used by psychologists to describe a range of thinking and behaviours. There are many ways of defining abnormality:

1. Statistical Infrequency

Behaviour that is rarely seen in the general population may be considered as abnormal. It's based on the idea that i measurable characteristics (e.g. intelligence) most people's scores will group around a central average. It will produce a normal distribution of scores. However, this method is not a sufficient measure for diagnosing abnormality., as does not show whether they are perfectly happy and function well in society.

2. Deviation from social norms

This denotes behaviour that can be seen as departure from what society or culture defines as acceptable. Involves a judgement based on the context in which the behaviour occurs. While there are behaviours which might be universally considered as morally unacceptable, much of what we consider socially acceptable has a strong cultural and historical context. Over time or within groups, there are huge discrepancies between what each would consider normal.

3. Maladaptiveness

Refers to when a persons way of thinking, emotional responses or actual behaviour is dangerous or prevents them from functioning well. Might be because they are deliberately self harming or less directly, their behaviour might impend on success in relationships or ability to hold down a job. This definition is broader than the other 2 as it allows for individual differences.

All 3 definitions play some role in the diagnosis of mental disorders, none is sufficient on its own.

Categorising mental health

The medical model of mental illness tries to determine the appropriate treatment for an individual by establishing categories of symptoms that from an identifiable disorder.

Psychiatrists use the Diagnostic and Statistical Manual of Mental Disorders (DSM) to classify abnormal behaviour and diagnose patients. Published in 1952 by the American Psychiatric Society. It contains descriptions, symptoms and other

criteria to allow reliable diagnoses of 157 disorders.

In the new editions of the DSM some disorders and removed or changed. Some changes reflect changes to social attitudes and conventions (e.g. replacement of 'mental retardation' with 'intellectual disability').

The DSM5 (newest edition) contains new disorders (such as disruptive mood dysregulation disorder). It also includes a new chapter on OCD and now includes 'hoarding disorder'.

ROSENHAN

Rosenhan and others have criticised the medical model of mental illness as part of the 'anti-psychiatry movement'. While they accept that mental suffering and deviant behaviour do exist, they question whether the most useful way of understanding such behaviour id through a rigid system of classification.

One of the most serious criticisms levelled at psychiatry is that is that it actually increases thew sufferings of those who receive a diagnosis. It removes control from patients, who can then be manipulated for political or social purposes.

A 2nd concern was the reliability and validity of diagnosis.

AIM: To investigate whether the sane can be reliably and accurately distinguished from the insane

Study 1: Involved finding out whether normal, sane individuals would be admitted to psychiatric hospitals to see if and how they would be discovered.

Study 2: Involved examining whether genuine patients would be misidentified as 'sane' by various hospital staff.

STUDY 1

SAMPLE

8 psuedopatients (including Rosenhan).

Aged 20+.

Various professions (e.g. psychologist, housewife, student. psychiatrist, painter).

3 female. 5 male.

All used fake names

Those in a mental health occupation used an alternative to avoid attracting special attention from staff.

12 hospitals chosen, across 5 different states of US.

Ranged from old to modern hospitals.

Ranged from private, public and uni funded.

Staff to patient ratio ratios varied greatly.

METHOD

Field experiment

IV= 12 hospitals

DV= Admission of ps top hospital, diagnosis received and the recordings of experiences on the ward

Psuedopatient arrived at admissions office of the hospital and asserted that they had been hearing unclear voices but were saying 'empty' 'hollow' and 'thud'., These words were chosen as they thought to imply a crisis about one's existence, but was no literature linking this to a known mental health disorder. Psuedopatients all reported that voices were unfamiliar and of same sex

Psuedopatients entered study understanding that they had to be released by convincing staff they weer sane.

On the ward, they behaved 'normally' and attempted to engage others in conversation. They indicated to staff that they were no longer experiencing symptoms

they obeyed the rules and routines of the ward and pretended to take medication

Psuedopatients found the experience as a whole distressing and unpleasant , nursing staff recorded in their notes that they were friendly and cooperative.

In 4 hospitals, the psuedopatients observed staff responses to a specific request. They approached a staff m,ember and asked 'When am I likely to be discharged?' These responses were recorded and compared to a control condition at Stanford Uni that involved asking uni staff a similarly simple question.

RESULTS

Psuedopatients successfully admitted to 12 hospitals.

Despite not showing any symptoms of insanity when in the hospitals, psuedopatients were not detected by staff. Failure to recognise sanity was not related to quality of hospital.

All (except 1) received a diagnosis of schizophrenia and were discharged with a diagnosis of 'schizophrenia in remission'. Patients carried a label of mental illness beyond the hospital.

Length of stay ranged from 7-52 days. Average 19 days.

During the first 3 trials, 35 out of 118 genuine patients voiced suspicions about the sanity of psuedopatients. None of the hospital staff raised concerns.

Rosenhan found a Type 1 error (when a healthy person is diagnosed as ill)

Rosenhan found that, once admitted to hospital, subsequent behaviour was interpreted in the light of their diagnosis.. he calls this the 'stickiness of psychodiagnostic labels'. Examples of 'pathological behaviour from the observers experiences included:

1) When pacing the corridors from boredom, they were asked by the nurses whether they were nervous

2) When recording behaviour in notes on the ward, they were described by the nurse as 'engaging in writing behaviour'

3) When waiting outside the cafeteria before lunch, they were described as demonstrating 'oral-acquisitive' nature of their conditions

Experience of hospitalisation was overwhelmingly negative and unpleasant. Hospital staff avoided interaction with patients. On average, attendants only spent 11.3% of their time seeking staff interaction. Individuals experienced depersonalisation from psychiatrist and more cooperation from lower ranked staff and interns.

Powerlessness (refers to the loss of authority or control an individual has to make their own legal or personal decisions) was evident. Personal privacy was inadequate (e.g. patients rooms could be entered and examined by any member of staff without warning or justification)(e.g. no toilet doors)

Depersonalisation (loss of the sense of personhood: ceased to be treated as individuals) was also evident. Ward staff attendants engaged in psychical abuse of patients, not in presence of other staff (who were perceived as credible witnesses unlike other patients). In one instance, a nurse undid her bra to adjust it in full view of male patients. A total of 2100 pills were administered to psuedopatients but only 2 swallowed. Many other patients disposed of medication but was not challenged by staff as long as they were still cooperative. Rosenhan argues that this is due to the staffs attitudes towards the mentally ill affected their treatment of the patients. They may have distrusted or feared patients , while also wanting to help them,. Leading yo them avoiding interaction with patients. ALSO, may be due to the hierarchical structure. Those with a higher status had less contact with patients. Average daily contact time with doctoral staff per patient was 6.8 mins.

Rosenhan is highly critical of diagnostic labels. Describes them as 'counter-therapeutic' suggesting hat they do more harm than good.

He also criticises the environment, describing psychiatric hospitals as special environments 'in which the meaning of behaviour can be easily misunderstood.

Rosenhan supports alternative models of treatment (e.g. care in the community) as they could potentially reduce the stigma associated with being institutionalised, and allowed the patient to gain a degree of control.

STUDY 2

SAMPLE

Ps were psychiatric staff at one research and teaching hospital who had been debriefed on the findings of the main study

Judgements were made on 193 patients who were admitted for psychiatric treatment.

METHOD

Staff were informed at some point that during a 3 month period, one or more psuedopatients would attempt to gain admission into the hospital.

Each staff were asked to rate each patient according o the likelihood that the patient was an imposter.

10 point rating scale used. 1= strongest belief that patient was a psuedopatient 10= strongest belief patient was genuine

RESULTS

All staff that had close contact with or responsibility for the patient made a judgement

Found that 41 of patients admitted were rated with high confidence to be psuedopatients by at least 1 member of staff

23 of these were suspected by at least 1 psychiatrist

19 were suspected by a psychiatrist and at least one other staff member

No psuedopatients actually presented to hospital for admission

Gives evidence to Rosenhans argument about the lack of reliability in diagnosis.

Staff committed a type 2 error by identifying mentally ill patients as healthy.

CONCLUSIONS

Rosenhans research challenges the idea that psychiatric professionals can effectively distinguish between sane individuals and insane. He found that:

Psychiatrists are unable to reliably identify sane patients (Type 1 error: False positive)

Psychiatrists fail to reliably detect insanity (Type 2 error: False negative)

Within the 'insane' environment of the psychiatric hospital, an individual's behaviour is perceived in a distorted manner, which can maintain a diagnostic label.

Application: Characteristics of Mental Disorders

Affective Disorder: Depression

Include a broad range of illnesses affecting mood which can range from mild to severe

Typically individuals may experience a marked feeling of sadness, emptiness or irritability.

They have a damaging impact on the individuals capacity to function

Symptoms of major depressive disorder

Main symptoms (present in past 2 weeks)

Depressed mood for most or all of the day, nearly every day

Loss of interest or pleasure in all or most activities

Other possible symptoms

Significant weight/appetite loss or gain

Frequent insomnia or hypersomnia

Inability to relax or sit still, or excessive lethargy

Daily fatigue or loss of energy

Excessive feelings of worthlessness or guilt

Loss of concentration or ability to think

Recurrent thoughts of death, suicidal ideation, suicide attempt or plan

These symptoms must be present every day or nearly everyday to be considered as part of a diagnosis, over the course of at least 2 consecutive weeks.

Only the main symptoms are essential

Instances of Major Depressive Disorder tend to begin at puberty and peak in the 18-29 year old range.

Females experience this disorder 1.5 to 3 times higher rates than males.

In children and adolescents, mood may appear irritable rather than sad.

Major depressive eppisodes can reoccur and vary in severity

Psychotic Disorder: Schizophrenia

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