history of mental health

• prehistoric views

  it was believed that mental illness was caused by evil spirits trapped inside someone.trephination was common

  *possession of evil spirits believed to be a punishment from the gods for misdeeds and wrong doing

  *exorcisms were used to remove demonic possession

  trephination was still used in 1800's to treat depression, schizophrenia and mania.burning witches was common practice - hysteria and epilepsy were frequently confused with witchcraft/demonic possession, and as these were more prevalent in women more women were burned as witches (this began to fade in the 1500s due to greater understanding of epilepsy)
• trephanation

  surgical procedure involving drilling hole into skull from which spirits were supposedly released
• imbalance of humours

  *Hippocrates (Ancient Greek physician) was the first to theorise that mental health was caused by physical entities - believed that madness resulted from an imbalance of 4 bodily fluids and could be cured by balancing them

  *each fluid was linked to a certain behaviour

  *e.g. depression was thought to be a result of an excess of black bile and certain diets and laxatives would re-balance this excess.

  *due to this, there was a greater understanding that people with mental health issues should be looked after and that they can be treated with physical remedies.
• imbalance of humours - bodily fluids

  *blood(courageous, hopeful, playful)*yellow bile(impulsive, ambitious, restless)*black bile(introvert, quiet, serious)*phlegm(calm, patient, peaceful)
• psychiatric treatment

  *until 19th century, there was no public provision for those suffering mental illness and most ended up in workhouses, prisons or private 'madhouses' - generally highly unsuitable settings as they were run for profit rather than for therapeutic benefit of residents

  *1247 - Bethlem Royal Hospital opened in London - Britain's first mental institution. the hospital regime was a mixture of punishment and religious devotion. Bethlem was associated with scandal and abuse in the public mind (given nickname Bedlam).

  *1500s more mental asylums were built to house and confine the mentally ill - many were institutionalised against their will and popular treatments included bleeding, purging and cold bathing to shock their minds back into a normal state. gyrating chair was intended to shake up blood and tissue of body to restore equilibrium but instead left patients unconscious
• The Madhouse Act of 1774


  *introduced licensing and inspections of madhouses and towards the start of the 19th century each region of the UK had a mandate to care for their mentally ill in lunatic asylums*act of publicly viewing inmates at madhouses and asylums continued until as late as 1815 (was done at a fee to the institution)*start of 1900s -people began to view mental health asylums as poor treatment towards the mentally insane*in the UK religious group called Quakers led early humanitarian reform of asylums - residents were encouraged to rest, engage in physical work (e.g gardening) and talk with others*one of the most significant advances in mental health treatment was the introduction of medication for the asylum patients e.g chlorpromazine (first antipsychotic drug)*around this time, modern psychology was responsible for the acceptance that mental illness is a result of influences on mind, which can vary from biological influences such as disease to the unconscious conflicts of Freud’s theory - he put forward his Psychogenic ideas and suggested that unconscious thoughts and emotions were a key contributor to mental illness.*Freud’s treatment known as Psychoanalysis aimed to gain insight into an individuals’ unconscious mind - often used Free Association which involved the patient expressing their thoughts exactly as they occur and also used dream analysis (as they were not censored so our unconscious thoughts are expressed)
• anti-psychiatry movement

  mental illness is explained in terms of biological dysfunction e.g brain dysfunction or genetic abnormalities - MEDICAL MODEL - became very dominant view point in 20th century and led to treatments like ECT, brain surgery and psychopharmacology e.g. drug treatments.chemical and medical techniques are often still used today.

  *some psychologists were against the medical model at this time. one of the most serious criticisms is that it actually increases the suffering of people who receive a mental health diagnosis because it removes control from patients who can then be manipulated for political or social purposes. also, how reliable and valid are the diagnoses given?
• definition of abnormality - statistical infrequency

  behaviour that's rarely seen in the general population is seen as abnormal
• definition of abnormality - maladaptiveness

  when someone is unable to live a normal life adequately they're seen as abnormal - their way of thinking, emotional responses or actual behaviour is dangerous or prevents them from functioning well (broader explanation as it allows for individual differences)
• definition of abnormality - social norms

  every society has societal norms that it maintains through laws, guidelines or societal pressure - an idea of how we're meant to act. anyone who behaves differently or deviates from social norms are seen as abnormal
• categorising mental health - DSM-5

  *Diagnostic Statistical Manual of Mental Disorders (DSM-5)*published by APA in 1952*manual containing information regarding every official psychiatric disorder*each diagnostic listing contains detailed info about the specific criteria required for diagnosis as well as a thorough overview of that disorder*clinicians go through the diagnostic features and decide which symptoms best reflects the behaviour they are displaying*more holistic as it uses a ‘multi-axel’ system that looks at all the features and categories first and builds a picture of how the person copes and engages with the world around them - sub-categories help eliminate certain mental disorders and help build the most accurate diagnosis*DSM is constantly adapting and changing to try and make diagnosis as reliable and accurate as possible*three main sections:Section I- instructional part that helps person use the manual in the most effective waySection II- includes 20 categories of disorders - in each category disorders are listed in lifespan order (relevant disorders that might appear in childhood come first in each chapter)Section III- provides assessment tools for disorders + a section about culture which aims to reduce cultural bias. *highlights disorders that appear to exist but further research is needed to establish better reliability & validity of diagnoses.
• changes that occurred between DSM IV and DSM V

  *'Autism spectrum disorder' is new name encompassing four previously separate disorders (autism disorder, Asperger's disorder, childhood disintegrative, pervasive development disorder)

  *New version contains several new depressive disorders

  *'Hoarding disorder' is also included
• positives of identifying/categorising disorders

  *helps establish reliable way to categorise and diagnose behaviours

  *helps direct most appropriate treatment for the individual

  *helps individual come to terms with and understand why they are different

  *incorporates the latest findings in neuroimaging and genetics have into each disorder along with gender and cultural considerations

  *new disorders have been added/adapted to fit in with clinical practice and research

  *it's constantly adapting and changing to try and make diagnosis reliable and accurate
• issues with identifying/categorising disorders

  *highly subjective - health professionals can have different opinions

  *requires self-report from individuals (risk of social desirability effects)

  *significant overlap between disorders which may make diagnosis more difficult

  *ethnocentrism - depends on culture to how behaviour is perceived, some cultures may see behaviours as the norm where others wouldn't

  *difficult to diagnose reliably due to individual differences and bias

  *no aim to explain why a disorder might occur

  *ignores biological symptoms as it only focuses on behavioural symptoms