L2 - Understanding + treating mental health problems

• Aetiology - the origin or cause of a disorder
• Prehistory - suggests mental health problems are caused by...

  • Possession by evil spirits/demons
  • Trephination
  • Exorcism
• Hippocrates (470-377 B.C.)

  • ‘Father’ of modern Western medicine – concept of the 4 humours
  • Mental health disorders:  like any other disease of the body - Brain pathology, head trauma, genetics
• Galen (129 - 198 A.D)

  Hippocratic-Galenic Approach -> Humoural Theory of disorders
• 4 humours:

  1. Sanguine
  2. Phlegmatic
  3. Choleric
  4. Melancholic

  Treatments: regulate environment to restore balance; change in diet; bloodletting; immersion in cold water

  
• Middle Ages - Continuation of early ideas i.e. humours.

  • Recognised the role of environmental factors (emotional shock, physical illness or injury, grief)
  • Treatments: bleeding, purging, whipping
• [Middle ages]

  Influence of the church

  • “madness” was a moral failing, evidence of sin
  • Evidence of witchcraft or possession by the devil
  • Treatments: exorcism, fasting, prayer
  • First asylums appear to house the mentally ill
• Renaissance

  • Humanism – worldview emphasising human welfare.
  • Decline of supernatural explanations for mental illness.
• [Renaissance]

  Asylums: places set aside for people with mental disorder

  • Patients treated almost as ‘inmates’

  Hospital of Saint Mary of Bethlehem – ‘Bedlam’

  • Very harsh, inhumane conditions: filthy, furnished with straw, patients chained to walls or locked in small boxes
  • Public show for visitors
• Reform movement - moral treatment

  Pinel (1745 – 1826)

  • Unchained ‘inmates’ at La Bicêtre Hospital•Advocated moral guidance and humane techniques
• Reform movement - moral treatment

  William Tuke (1732 - 1822)

  • Established the York retreat in England
  • County Asylums Act of 1845
• Reform movement - moral treatment

  Dorothea Dix (1802 – 1887)

  • Mental Hygiene Movement
• Emergence of modern views

  Richard von Krafft Ebing (1840 – 1902)

  • Link between General paresis and syphilis
• Emergence of modern view

  Emil Kraepelin (1856 – 1926)

  • Importance of brain pathology in mental health disorder
  • System for classifying symptoms into discrete disorders or “syndromes”
  • Measured effects of drugs on disordered behaviour
  • Treatments: e.g. lobotomy
• Medical Model

  • Behaviour affected by changes in brain/nervous system
  • Mental health problems viewed in same way as physical illness

  Implications

  • Dichotomy between ‘normal’ and ‘disordered’ states
  • Biological factors are primary in development of disorder
  • Diagnosis treated not individual
• Therapies:

  Psychological problems result from physical problems → change physical state

  • Drug therapy
  • Electroconvulsive therapy
  • Psychosurgery
• Symptoms usually co-occurring = syndrome
• Why Classify?

  • Same diagnosis across world
  • Same treatment across world
  • Research focuses on same condition across world
• [Issues] Reliability: consistency of judgements

  • Boundaries between disorders can be unclear
• [Issues] Reliability

  • Cross-cultural Inconsistencies  - e.g. Mikton & Grounds (2007) – ethnicity of diagnosing physician influences diagnosis
  • Barnes (2008) looked at the ethnicity of patient on diagnosis

  
• Role of culture - What is considered “normal” in one society might not be in another.

  e.g. notions of witchcraft may be considered delusional in some cultures, but common amongst others.
• “Culturally bound syndromes” are specific to a certain place/culture/group.

  25 were listed in the DSM IV, but the DSM V takes a different approach, considering culture-related diagnostic issues for each condition and listing 9 “Cultural concepts of distress”
• “Ataque de Nervios” amongst people of Latino descent. Symptoms include intense emotional upset, crying, trembling and aggression.
• “Taijin Kyofusho” in Japan. Symptoms include anxiety about and avoidance of social situations due to a fear that one’s actions and/or appearance will offend others.
• Benefits of diagnosis:

  • Allows a way of understanding and communicating what’s happening for both patients and clinicians.
  • Some people find it very helpful to have a diagnosis that explains what they are experiencing
  • Situation is not unique or inexplicable
  • Can reduce feelings of blame or guilt
  • Guides decision about treatment plans
  • Facilitates access to services and support.
• [Labelling] Rosenhan (1973) – Pseudopatient study

  
  

  ‘On being sane in insane places’

  • 8 individuals presented themselves to psychiatric hospital
  • Auditory hallucinations, hearing voices
  • All other questions answered truthfully
  • Majority admitted with diagnosis of schizophrenia
  • In hospital: stopped reporting voices, behaved as normal, cooperated with staff
• [Labelling] Rosenhan (1973) – Pseudopatient study

  • Hospitalisation from 7 – 52 days (average length of stay: 19

       days)

  • Diagnosis – label – affected staff perceptions of pseudo-patients’ relationships and behaviour
  • None detected; discharged as ‘schizophrenic in remission’
  • Labels are ‘sticky’ = Stigma -> Self-fulfilling Prophecy
• [Stigma + Self-fulfilling prophecy]

  Harris et al (1992): Expectations of behavioural disorder (ADHD)

  • Pairs of boys aged 6-12 yrs

  Perceivers: typically developing (TD) boys

  Targets: TD boys or boys with ADHD

  Expectancy manipulation

  “He’s in a  special class for his behaviour.  He gets in trouble a lot for disrupting the class, talking when he shouldn’t…”
• [Stigma + Self-fulfilling prophecy]

  Harris et al (1992): Expectations of behavioural disorder (ADHD)

  Measures:

  • Questionnaire data e.g.   How well do you think your partner did? 3 good/bad things about partner – Globality rating
  • Behavioural data - Interactions videotaped and rated e.g.   Time spent talking -> Friendliness
• [Stigma + Self-fulfilling prophecy]

  Perceiver effects:

  
• [Stigma + Self-fulfilling prophecy]

  Target effects:

  • Lower enjoyment
  • Lower self-credit for task
• [problems with medical model]

  • Behaviour affected by changes in brain/nervous system
  • Mental health problems viewed in same way as physical illness

  Implications

  • Dichotomy between ‘normal’ and ‘disordered’ states

  BUT many ‘disordered’ states found to occur in large numbers of ‘normal’ population

  • Biological factors are primary in development of disorder

  BUT social and psychological factors also critical

  • Diagnosis treated not individual

  BUT this fails to recognise experience of the person
• [Alternatives to medical model]

  According to Bennet (2011), an alternative must:

  • Make no dichotomy between ‘normal’ and ‘disordered’ states
  • Consider social and psychological factors
  • Make the individual the focus of treatment
  • Consider non-pharmacological interventions as primary

  Dimensional Approach

  • Mental health disorders exist on a spectrum

  But: does not address processes causing/maintaining disorder -> Formulation