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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The Historical Context of Mental Illness

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 STUDY

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

Schizophrenia is a long term mental health condition that affects peoples thought, emotions and behavior.

Psychotic disorder refers to the experience of the disorder as a loss of contact with reality; tose with the diagnosis come to perceive things around them as differently from others

Symptoms of schizophrenia are described as 'positive' or 'negative'

Positive symptoms = refer to the addition of new behaviours (e.g. hallucinations)

Negative symptoms = include a removal or loss of normal function (e.g. reduction in speech)

Hallucinations = Takes many forms. Involve seeing, hearing and feeling things that aren't there

Delusions = refers to beliefs people may have that are not based on reality (e.g. paranoid belief that healthcare assistant is 'out to get' the person who is ill, when they are trying to help)

Symptoms are not immediately recognizable. Changes may begin slowly e.g. in the form of social withdrawal

Symptoms of Schizophrenia

Main symptoms

Delusions

Hallucinations

Disorganised speech

Other symptoms

Highly disorganized or catatonic behaviour

Negative symptoms (e.g. reduced expression of emotion)

1 in 100 people are diagnosed with schizophrenia. Fairly common

Males typically diagnosed late teens. Females typically diagnoses several years late (approx.25)

Those who have been diagnosed will never be 'cured' and are likely to require on going treatment to help manage their symptoms.

Anxiety Disorder: Specific Phobias

Involve feelings and behaviours characterized by excessive and persistent fear or anxiety.

Fear is an emotional response to a real (a perceived) threat

Anxiety is the expectation of that threat

The negative feelings towards to particular thing is extreme and have a serious impact on lives

Specific phobias are one type of anxiety disorder affecting around 6% of the UK

Common phobic stimuli are:

1) Animals (e.g. dogs)

2) Natural Environment (e.g. heights)

3) Situations (e.g. travelling in a plane)

4) Injury (e.g. Blood)However, there are a huge variety of unusual phobias (e.g. feathers)

Symptoms of specific phobia

Phobic stimulus provokes immediate fear and anxiety

Phobic stimulus is deliberately avoided or eruded with strong anxiety or fear

Fear and anxiety caused by stimulus is disapropiate to the actual danger poses

Phobic distress is persistent (lasts 6 or more months)

Phobia caused significant distress and impairment in areas of functioning (such as social life or work)

A phobia is an intense, severe and irrational fear that produces a psychological response (e.g. sweating.shaking)

The anticipation of the phobic stimulus can induce anxiety

Phobia likely to have a significant impact on their lives and prevent normal functioning

Individuals often realise that their reaction is disproportionate

Animal and natural phobias most common in females

Blood and jury type phobias are equal by both genders

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The Medical Model

Biochemical Explanation of Mental Illness

Brain cells transmit in the form of electrical impulses around the brain in order for us to think, feel and make decisions.

Chemicals (neurotransmitters) pass across synapses to pass info across.

Explanation for mental illness involves the possibility that symptoms are a result of abnormal neurotransmitter levels or action.

Monoamine Hypothesis of depression

Monoamines (group of neurotransmitters) appear to be involved with depression

Include Serotonin, noradrenaline and dopamine

Depression involves lowered mood and disruption to activity levels

Dopamine has an important role in regulating mood

Noradrenaline is implicated in activity levels

Serotonin may be important in controlling the activity of noradrenaline and dopamine

One version of this hypothesis says that reductions in Serotonin levels (which typically follow stressful events) lead to a failure to regulate normal dopamine and noradrenaline functions

Another versions says the disruption to monoamine levels is the result of abnormally high levels of an enzyme that breaks down the monoamines, reducing their action and disrupting the passage of info around the brain

Dopamine Hypothesis of Schizophrenia

Dopamine believed to be important in the functioning of sever brain systems that may be implicated in the symptoms of Schizophrenia

Early versions of this hypothesis identified high levels of Dopamine in some areas of the brain,l which could account for some symptoms of Schizophrenia (e.g. hallucinations)

More recently, the hypothesis has focused more on reduced Dopamine levels or activity in the brain (GOLDMAN-RAKIC et al (2004)) that low levels in the pre-frontal cortex, which is responsible for thinking and decision making, may explain other symptoms of schizophrenia (e.g.incoherent thought or speech)

Possible that both hypotheses are correct, and that disruption to the Dopamine systems in different oparts of the brain may be responsible for different Schizophrenic symptoms.

Genetic Explanations for Mental Illness

Inherit half genetic material for mother. Half father.

Genes= Sections of DNA that contain the instructions for producing physical structures (including brain and organic chemicals (e.g. neurotransmitters and the enzymes that break them down))

Possible that genes exert an influence on individual psychological factors (e.g. mental illness) by influencing the nature of physical structures of chemical levels in the central nervous system

Unlikely that mental Illness is purely the result of genetic factors but it appears that people are more vulnerable than others to developing them due to their genetic make up.

Schizophrenia seems to be more heavily influenced by genetic variations than depression

Genetic Vulnerability to Depression

No suggestion that most types of depression are primarily the result of genetic vulnerability

Strongest predictor is stressful life events

We do not all respond to stress in the same way, some people are more resilient than others. Genes may effect how resilient or vulnerable an individual is to impact of life-stress

Modern research is looking at particular genes and how those genes may interact with the environment together influencing symptoms

Researchers been interested in Serotnin transporter gene (responsible for producing serotonin)

Gene comes in 3 forms varying in length of its 2 strands: long-long; long-short; short-short.

Believed that short form leads to inefficient serotonin production

May mean that people with short-short form are less resilient than others to the effects of stress and are more vulnerable to responding to stress with depression

Genetic Vulnerability to Schizophrenia

Schizophrenia runs in families

However, doesn't mean that it is genetic in its origin as family tend to share aspects of their environment aswell.

Schizophrenia is generally genetically influenced

Used to be believed that there was a single 'schizogene' that made some people particularity vulnerable to Schizophrenia (MEEHL (1962))

Schizophrenia can be described as polygenic as a number of genetic variations can make us more vulnerable

Also appears to be aetiologically heterogeneous (different combos of factors can lead to similar symptoms

This makes it hard to pin down what genes might be involved in Schizophrenia and they they might lead to symptoms

RIPKE at al (2014) combined all previous data from studies linking variations across he whole human genome to schizophrenia. Found that genes associated with increased vulnerability to developing Schizophrenia included those coding for the functioning of a number of neurotransmitters (including Dopamine).

This is significant as shows how genetic vulnerability and the Dopamine Hypothesis can be linked and understood together

Brain Abnormality

Brain structure and function are associated with mental illness

Certain structures in the brain may develop with a different size or shape, and levels of electrical activity can be higher or lower in particular brain areas.

Evidence showing that our central nervous systems so not function normally when we suffer from certain conditions. Particular areas also appear to malfunction during mental disorder, although it is unclear whether this is due to the abnormal neurotransmitter level or to a separate phenomenon

Brain Abnormality in Depression

Some evidence

Some studies have suggested that a role for the frontal lobes, region at front of brain cortex that is particularly involved in thinking

COFFEY et al (1993) compared the size of frontal lobes in depressed patients and non-depressed controls using MRI scanning, and found that the mean control lobe volume in the depressed patients was significantly smaller

MILO et al (2001) PET scan study showed that the frontal lobes in depressed patients do not draw on blood flow in the brain as they normally do. He found that blood flow to the frontal lobes improved immediately following ECT, suggesting that ECT works

Brain Abnormality in Schizophrenia

Evidence to suggest that in Schizophrenia the left hemisphere of the brain does not function normally

PURDON et al (2001) compared the force applied with the right and left hand in 21 patients with Schizophrenia and in a control group. 10 of the treatment group were given anti-psychotic medication and tested again. The untreated group were significantly weaker in the right hand, though not the left. This effect disappeared after treatment. This suggests that schizophrenia involves a problem with with the left-brain, and that anti-psychotic drugs help correct this

Also evidence to suggest that negative symptoms are associated with brain abnormalities

Motivation (in particular the anticipation of reward) is believed to involve the ventral striatum.

JUCKEL et al. (2006) have measured activity levels in the ventral striatum in Schizophrenia and found lower levels of activity than those observed in controls. Also found that a negative correlation between activity levels in the ventral striatum and the severity of overall negative symptoms. This suggests that at least this symptom of schizophrenia is connected to abnormal function of the ventral striatum

Hallucinations are also associated with abnormal brain function

ALLEN et al (2007) scanned the brains of patients experiencing auditory

hallucinations, and compared them to controls, while they identified segments of

pre-recorded speech as either their own or from other people. Lower activation

levels in 2 brain regions (superior temporal gyrus and anterior cingulate

gyrus) were found in the hallucination

group, who also made more errors than the control groups. It can be concluded

that abnormal function in these areas is associated with hallucinations in

schizophrenia.

GOTTESMAN RESEARCH

AIM

To examine how vulnerable the children of 2 parents with

mental illness are to developing a mental illness themselves.

SAMPLE

Participants drawn from a population of approx. 2.7

million Danish people born before 1997 who had an identifiable mother and

father.

Data was sampled in 2007

Min. age of participants was 10 years.

From

this population, 196 couples selected, both of who had a diagnosis of

schizophrenia, and their 270 children; and 83 who had a diagnosis of bipolar

disorder, and their 146 children.

METHOD

Cohort study (involved looking at a cohort of a population)

IV= parental schizophrenia or bipolar disorder. Operationalised as parents receiving a diagnosis was in accordance with the World Health Organisation's system for Classification and diagnosis of mental illness: the International Classification of Disease (ICD)

DV= Diagnosis of any mental illness. Operationalised as diagnosis was according to ICD

RESULTS

For both Schizophrenia and bipolar disorder he risk of mental illness was much more greater for offspring with 2 parents having a diagnosis:

27.3% of offspring with both parents with Schizophrenia had developed it by age 52, rising to 39.2% for schizophrenia and other related conditions, and 67.5% developed a mental illness.

For offspring with one parent diagnosed with schizophrenia: 7% diagnosed with Schizophrenia; 11.9% for any diagnosis

With no Schizophrenic parents: risk was 1.12% for schizophrenia; 14.1% for any mental illness.

Figures similar for bipolar disorder

2 parents: 24.95% developed bipolar disorder by age 52; 36% developing either bipolar disorder or depression; 44.2% developing a mental illness

1 parent: 4.4% developed bipolar disorder

0 parents: 9.2% developing a mental illness

CONCLUSIONS

Having both parents with a serious mental illness is associated with a significantly not only that disorder but mental illness in general.

Having 1 parent with a mental illness carries a lower risk

This provides useful info for genetic counselling, which involves advising people of their own risks of developing an illness or of passing on genetic vulnerability to their children

Application: Biological treatments

Antidepressant drugs

Generally work by raising levels of monamine neurotransmitters in the brain

Monaimine oxidase inhibitors prevent the breakdown of serotonin, noradrenaline and dopamine- so all levels build up

Tricyclics prevent serotonin and noradrenaline being reabsorbed after they have crosses a synapse, increasing their levels

Effective in reducing symptoms because they interfere with a number of neurotransmitters, they can have serious side effects (e.g. drowsiness)

Newer antidepressants tend to work on 1 monoamine

Important to have a number of antidepressants as individuals can vary in how they respond.

The antidepressants given can depend on gender

ECT (Electroconvulsive Therapy)

Involves administering an electric shock inducing a seizure (usually lasts 15-60 seconds)

Bilateral shocks *both sides of head) seems to be more effective than unilateral (one side), although its more likely to lead to side effects

Typical course of treatment runs 2-3 weeks, with ECT being repeated 6-12 times

Modern ECT involves small shocks for small periods of time, under anaesthetic, using drugs to paralyse muscle and prevent broken bones

Evaluation

Ethics

Serious ethical issues, in particular with treatments

Widely believed, drugs in hospitals given to make patients easier to handle, rather than to benefit them

Antipsychotics have side effects, such as long term - central nervous system damage , short term - dizziness. Occasionally can produce a fatal powerful reaction (neuroleptic malignant syndrome)

Usefulness

Research has led to a rise in treatments and how effect they are likely to be

Evidence to support that antipsychotics are effective in tackling schizophrenia

Nature vs Nurture

Primarily nature

Emphasis on genetic vulnerability and the bio factors (e.g. abnormal brain structure)

HOWEVER doesn't ignore environmental factors, looks at the aspects of the biological environment (e.g. oxygen starvation during birth has been exposed in relation to mental health)\

Freewill vs determinism

Fairly deterministic

Symptoms seen to be determined by brain or biochemical abnormality, which are determined by genetic vulnerability or some aspect of bio environment

Reductionism and holism

Biological Deterministic

Mind rescued to the brain and many aspects of human experience are reduced to biological events

Biological approach misses out on the complexity of humans

HOWEVER not possible to study whole of human nature at same time, so it is necessary for the scientific approach

Individual vs situational

Emphasises the role of genetics, brain chemistry and abnormal brain structure/function in individual differences between people

HOWEVER, some argue that its not just influenced by individual differences but situations we are in (e.g. poverty, stressful events). These factors not taken into account when biomedical approach is adopted

Psychology as a science

Scientific

Firmly based on research and explanations are supported by research

Scientific techniques used (e.g. Scanning used to study brain abnormality)

Emphasises on scientific techniques

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Alternatives to the Medical Model

Behaviourist Explanation of mental illness

Abnormal behaviour is assumed to be learned

Can occur through classical and operant conditioning

Classical conditioning

Happens when an emotional repsonse (e.g.fear) becomes associated with a particular stimulus.

PAVLOV (1903) taught dogs to salivate when they heard a bell

If a person is regularly exposed to a stimulus with an unpleasant experience then the stimulus will become associated with the fear

LITTLE ALBERT- presented with white ran and then a loud bang. Associated the loud bang with the rat. Developed a fearful response when presented with the rat even when the loud bang wasnt.

Operant Conditioning

Explains how the consequences of different behviours shape subsequent behaviours

Humans learn by consequnece : when behaviour is reinforced, becomes more likely to be repeated (SKINNER - white rats)

HOWEVER behaviouir that is not reinfoced but is punished, is less likely yo be repeated

Easily applied to addictive behaviour (e.g. gambling. If someone gambles and wins then behaviour is reinforced)

A reason gambling is addictive is due to schedule of reinforcement

Cognitive explanation of Mental Illness

Concerned with processes of thinking, attention and perception

Found that Behaviourist approach ignored the ability of people ro select on and consciously control their own behaviour

Addresses mental illness symptoms and causes through examining irrational and maladaptive beliefs

This explanation relies on the idea that cognitions of a person with a mental illness are faulty: it is the way they perceive situations that cause the difficulty

Cognitive distortions = irrational thinking (individual forms an inaccurate perception of reality)

Main cognitive distortion:

Over generalisation - Viewing one unfortunate event as part of a never ending defeat or struggle (e.g. 'Everything always goes wrong for me')

Filtering - Giving greater consideration and focus to negative aspects, while ignoring positive ones (e.g. 'It doesn't matter that I passed the test, I got a question wrong and let myself down')

Catastrophisation - feeling a situation/outcome is/will be worse than it actually is (e.g. I got the order Wong. I'm gonna get fired and never get a job again')

Dichotomous reasoning - All-or-nothing thinking (e.g. He's perfect and good at everything. Nothing goes wrong in his life)

BECK suggested that these maladaptive thinking patterns form in childhood as we acquire info about aspects of the world (scheme development)

Although difficult early experiences and dysfunctional beliefs may lead to the development of the negative cognitive triad (negative views about the world, about oneself, about the future) doesn't men the person will develop a mental disorder

BECK believes that the nature of sham formation and information processing can be changed through therapeutic techniques

Cognitive-Behvioural therapy for depression

Cognitive-behavioural therapy (CBT)

most common technique

usually takes place once a week. 5-20 min sessions

Involves helping patients to identify irrational and unhealthyelpful thoughts and trying to change them

Involves showing links between thinking, behaviour and emotions.

Idea that thoughts affect our behaviour and emotion, so changing thoughts should make us feel better

According to BABCP, aims of CBT are:

To re-estalish previous levels of activity

To re-establish social life

To challenge patterns of negative thinking

To learn to spot the early signs of recurring depression

Collaborative. patient and therapist agree on what the patients want to change

Challenge negative thoughts and encourage patients to get involved in something they used to enjoy

Evaluation

Usefulness

CBT widely considered useful

Recommended as first-line treatment for depression

BUTLER et al (2006) reviewed CBT studies. Based on the large body of evidence gathered, concluded that CBT was v. effective

Nature vs Nurture

Elements of both

Types of faulty cognitions that may cause depression are part of underlying cognitive structures (NATURE) that are influenced by learning and experience (NURTURE)

HOWEVER Behaviourist explanation purely NATURE, opposing that maladaptive behaviours (e.g. gambling/ irrational fear) are a product of external environmental stimuli

Freewill vs determinism

Behaviourist explanation fairly deterministic

Maladaptive behaviours seen as a product of interaction with environment, little to suggest we change change/influence them.

HOWEVER, cognitive approach suggests we can change our behaviour by changing our thoughts, which suggest freewill

Psychology as a science

Behavourists- highly scientific approach (e.g. seek to establish cause and effect)

Cognitive approach - hard to demonstrate empirically as they rely on clients self report.

CBT combines cognitive and behaviourist principles. seen as scientific as evidence based

Humanistic Explanation of Mental Illness

Aims to understand human nature using simple principles and minimum theory

Reject psychiatric diagnosis and complex theory , relying on basic assumptions about human nature instead

Include ideas that humans are good and have a tendency to grow as individuals and to fulfil their full potential

Classification and diagnosis is seen as unhelpful - persons symptoms better understood as they individual response to the blockage of their growth

Carl Rogers' theory

Proposed that understanding healthy psychological development depnds 2 ideas:

Actualising tendency

Self-concept

Actualising tendency

Rogers believed that humans are primarily motivated by the needto actualise (i.e. reach their full potential)

Relationship between environment and ability to actualise can be understood using the analogy of a flower, will only grow when conditions right. Can only reach full potential with good environmental conditions

Unconscious process of valuing guides us towards choosing behaviours that help us fulfill out potential

HOWEVER, this can be prevented by strict social rules and poor self concept

Self-concept

Rogers noticed inb therapy, patients would often make referenceto themseleves (e.g. I'm not being my real self')

Rogers placed importance of this emphasis on the self and how people thought of themselves

Rogers proposed that an aspect of self-concept is self-esteem (how much we like ourselves)

Believed that we hold an image of our self as how we currently are and our idel self. If 2 the same (congruent) will experience good self-esteem

Development of congrugenvce and high self esteem depends on recieving unconditional positive regard from other in form of acceptance, love, affection

Without unconditional positive regard we cannot self- actualise.

Children can lack it from their families (e.g. by harsh inattentive parenting). can lead to low self-esteem. Then can lead to mental disorders due to being vulnerable

Appplication: Humanistic therapy for depression

Humanist counsellors refer to individuals as 'clients'. Reflects the fact that they see the therapist and client as equal partners (rather than expert treating patient)

Encorage clients to focus on and explore feelings (BUT unlike psychodynamic therapists) not directive, refraining from asking clients to explain things they have said. Do not offer interpretations BUT encourage client to carry on in hope they will find their own answers

Rogers avoids interpretation as believed that more useful to focus on present and future rather than past

Core conditions for personal growth

Rogerians try to help clients achieve personal growth and to self-actualise.

Rogers (1961) suggested 3 core conditions:

Empathy- Ability to understand what client is feeling . Communicate with them that therpist understands and precisely follows

Congruence - Keen to allow the client to experience them as they really are

Unconditional positive regard- Rogers believed that for people to grow and reach full potential, important they are valued as themselves. Must maintain a positive attitude to the client.

Meanrs & Thorne (1988) - we cannot understand person-centered counselling by its techniques alone.

Humanistic psychology primarily a philosophical system . person-centered counsellor distinguished by their positive and optimistiv view of human nature

Evaluation

Usefulness

Practical applications in therapy and education

Rogers' idea that unconditional positive regard is of psychological benefit is the basis of humanistic therapy (person-centred counselling)

Widely considered to be a necessary element of all psychological therapies

Emphasis on individual free will important in education. Important to not see students potential as determined by prior experiences

Nature vs Nurture

Elements of both

Rogers mentioned humans need to receive unconditional positive regard to achieve good self-esteem. Innate (NATURE)

HOWEVER provision of positive regard is NURTURE, this nurture leads to a congruence between self and ideal self

Freewill vs Determinism

Least deterministic approach. Great emphasis on free will

Humanist psychologists believe we have the ability to make decisions about how we would like to be and to achieve that state

Reductionism vs Holism

Humanistic psychology looks at whole person (HOLISTIC)

Offers a realistic rather than oversimplified view of the person

Psychology as a science

Unscientific

Hard to study scientifically due to it being holistic rather than reductionist

The Psychodynamic Explanation of Mental Illnesses

Emphasises the influence of the unconscious mind on symptoms and the influence of early trauma and the quality of early relationships on later mental health

Freud's hydraulic model

Idea from literature phrases (e.g. 'to blow off steam'). Phrases suggest that the mind is system in which mental (psychic) energy behaves in the same way as physical energy.

Freud believes psychic energy could be discharged or transformed bu not destroyed

Trauma and the inability to express instincts resulted in a build up of psychic energy that led to symptoms o f mental disorder.

Freuds ideas about sexual trauma and fantasy

Emphasised that the role of childhood sexual abuse in causing psychological problems

In later work, Freud shifted emphasis fdrom real sexual abuse to sexual fantasy .

Freudian theory of depression

Freud proposed that some cases of depression could be linked to experiences of loss of a parent or rejection from parent.

Can cause low-esteem

Psychodynamic explanation for Schizophrenia

Fromm- Reichmann- proposed that where families were characterised by high emotional tension and secrecy, and where moth was cold and domineering, child had a high risk of developing schizophrenia

Application: Psychodynamic therapies for Depression

Originated from Freud's work.

No attempt to teach patient more constructive patterns of thinking or behaviour.

Therapy slightly less intensive and long term (on-3 rimes a week. 5 years) than used to be

Traditionally, patient and analyst don't face each other. Nowadays, facing each other

No attempt to teach patient more constructive patterns of thinking or behaviour.

Emphasis on exploring exploring patients past and linking to current symptoms

Early experiences of loss or rejection are particularly important to depression, so these in particular are being explored

Patients are educated about the links between their current functioning and their past experiences, rather than waiting for negative emotions to be transferred onto the therapist

Evaluation

Usefulness

Freudian theory proved useful for many people

Psychodynamic therapies aim to discharge pent up emotion and give patients insight into their condition and origin, can begin to exercise free will and prevent past experiences determining their symptoms- Useful application

Nature vs Nurture

Acknowledges importance in form of instincts (NATURE) and also in form of parenting (NURTURE)

Freewill vs determinism

Faily dterministic

Emphasises the way our current feelings and motives are determined by our unconscious mind

HOWEVER approach offers possibility of of freewill as we can gain some insight into these unconscious influences though dreams, slips of tongue and interpretations from therapist. Once we are aware of this we can make conscious decisions to act in particular ways

Psych as a science

Unscientific

Freud's ideas derived from self-analysis and interpretations, rather than scientific research.

Difficult to test ideas in a scientific manner, unconscious mind not observable.

Use of case studies. not replicable and can be interpreted in different ways

The Cognitive- neuropsychological explanation of mental illness

Based on our cognitive function and brain function

Brain function has a direct effect on cognitive function

Changes in brain function can manifest as changes in cognitive functions

Post Traumatic stress disorder can be a result of underlying abnormalities in brain function.

A cognitive neuropsychological model of post traumatic stress

Scott & Stradling (2001)- developed it by combining understanding of role of memory cues and activity of amygdala (area of brain)

PTSD - reexperiencing traumatic events with emotional and sensory experiences. Can be seen as a powerful cue-dependent memory, triggered by insignificant sights, sounds or smells related to the event

Tautmatic memories particularly associated with activity in amygdala

When 'alarm foes off in amygdala. Hippocampus trust it off

HOWEVER, people with PTSD have smaller hippo campuses so fails to turn 'alarm' off, causing flashbacks to event

A cognitive-neuropsychological model of schizophrenia

Schizophrenia characterised by disruption to normal info processing.

Negative symptoms associated with reduced activity in the ventral striatum

Frith (1992) identified 2 kinds of dysfunctional information processing caused by brain dysfunction that may underlie some symptoms of schizophrenia

Metarepresenation- Allows us insight into own thoughts and intentions. If impaired, may not be able to recognise own thoughts

Brain central control system- Suppresses automatic responses while we carry out deliberate behaviour.

Evaluation

Usefulness

Explains usefulness of of bio and cognitive approaches to treating mental disorders

Evidence to show most effective treatment for schizophrenia is through drugs and therapy

Nature v Nurture

Interactionist

Explains brain abnormality as due to genetic factors and experieneces

Freewill v determinism

Deterministic

Sees our cognitions and resulting behaviours are being determined by brain functioning

Reductionism v Holism

Reductionist

Reduces the complexity of the mind as an info processing system. ALSO reduces humanity to central nervous system

Oversimplifies human behaviour

KEY RESEARCH

SZASZ (2011)

AIM:

Szasz revises his essay 'The Myth of mental illnesses'

Considers the current medicalisation of abnormal behaviour in the light of his earlier arguments

METHOD:

Szasz looked at his essay on psychiatry and how it affects those who experinece mental health issues

FINDINGS:

1950- Szasz criticised medical model. Stated that patients treated like prisoners. mental illness is not a disease like a physical one. mental illnesses don't exist

50 years later- Us changed attitudes towards mental illness. 'Incurable' patients no longer confined. new legal responsibility to prevent patients causing harm to themselves and others

Poprosed that US mental health system has medicalised (can be diagnosed and treated accordingly) and politicised (those who hold power, openly declared mental illness is like a physical illness) mental disorders.

Believes credilibilty taken away from alternatives to medical model

Szasz rejects medical model as believes some mental illnesses are physical illness due to physical symptoms

Insanity in court highlights our negative perceptions as says mental disorder is reason for bad behaviour and removes persons repsonsibility

Conclusion

Medicalisation and polarisation of a psychiatry over the past 50 years had led to a dehumanised model of care

Mental illness should be regarded as a metaphor

Szasz rejects moral legitimacy of psychiatry as violates human liberty

Evaluation

Ethics

Doesn't collect data directly from participants so no ethical issues

HOWEVER, Szasz beliefs are highly controversial and produce socially sensitive research

People with mental illness, may find research distressing due to their illness being described as a myth

Usefulness

Huge impact on psychiatry and psychology

Influential in movements to empower service users in mental health

Makes us question effectiveness, appropriateness and morality of treatments

Nature v Nurture

Explains it is a social construct rather than biological

Not an abnormality experienced b individuals due to their biological or emotional functioning but is a product of psychiatrists views

Reductionsim v Holism

Holistic

Although symptoms may be real, the diagnosis they attract can be explained by a wider understanding of society and psychiatry processes of labelling