section 1

• The anti-psychiatry movement in the 1960s argued against the medical model/biological treatment of mental illness
• Statistical infrequency defines abnormality as statistically rare or outside the typical range of behaviour
• Deviation from social norms defines abnormality as behaviour that deviates from socially accepted standards
• Failure to function adequately defines abnormality as an inability to cope with life, work, and relationships
• Rosenhan and Seligman suggested that dysfunction includes personal distress, dysfunctional/maladaptive behaviour, and irrational behaviour
• Dysfunction


  When an individual has stopped experiencing a normal range of emotions or are not participating in their normal range of behaviours, leading to an inability to cope with life, work and relationships. The individual might not be able to get up and go to college, go shopping or have the social life they did before. They have stopped functioning normally and have reached a point of abnormality.
• Defining abnormality (Rosenhan & Seligman, 1989)


  • Personal Distress
  • Dysfunctional or Maladaptive Behaviour
  • Irrational behaviour
• Personal Distress


  Depression and anxiety disorders are common features. Distress is the main symptom of depression and can be experienced as intense unhappiness, sleep loss, constant tiredness.
• Dysfunctional or Maladaptive Behaviour


  Behaviour that stops an individual from attaining satisfactory personal and social goals. E.g. Alcoholism preventing someone from holding a job, fear of crowds preventing someone having a social life.
• Irrational behaviour


  If a person's behaviour does not appear to make any sense or they seem unable to communicate effectively with others. E.g. the speech of many schizophrenic patients is bizarre and disjointed and impossible to follow rationally.
• The DSM includes an assessment of ability to function called WHODAS (World Health Organisation Disability Assessment) and considers 6 areas: understanding and communicating, getting around, self-care, getting along with people, life activities and participation in society. Individuals rate each item on a scale of 1 to 5 and are given an overall score out of 18. Therefore an assessment of abnormality using the DSM would include a quantitative measure of functioning.
• Bipolar affects 1-2% of the general population and is therefore statistically rare.
• For the exam you need to be able to describe and evaluate all 3 definitions of abnormality.
• The medical model of mental illness tried to determine the appropriate treatment for an individual by establishing categories of symptoms that form an identifiable disorder.
• Manuals used to classify mental disorders

  • Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
  • International Classification of Disorders (ICD-10) created by WHO
• DSM


  Stands for Diagnostic and Statistical Manual of Mental Disorders. First DSM (1952) was based on a classification system used with soldiers in the second world war. Unlike the ICD, the DSM only contains mental illnesses as opposed to both mental and physical illnesses.
• Over the different editions (now on version 5) there have been many additions and omissions, such as homosexuality being in version 1 (DSM-1) and then removed in DSM-III, and premenstrual dysphoric disorder now being in DSM-5.
• The DSM undergoes reviews and developments. Changes to disorders and their descriptions can be included after a sizeable body of research has been undertaken.
• Some of the biggest changes between DSM-IV & DSM-5 are in categorisations such as removing the subtypes of schizophrenia and removing the types of autism.
• The structure of the DSM has significantly changed, removing the "multiaxial" system. This was a way of ensuring holism of diagnosing, where the doctor would rate individuals on factors like physical illness and global functioning.
• Sections in the DSM-5

  • Describes the process of revising the DSM and how the current manual is to be used
  • Includes 20 categories of disorders (depressive disorders/anxiety disorders/gender dysphoria/addictive disorders). Within each category the disorders are listed in lifespan order. Most disorders now come with a spectrum of severity
  • Provides assessment tools for specific disorders and disorders in general. Discusses cultural concepts of disorders to reduce cultural bias. Also includes disorders that appear to exist but need further research.
• Possible diagnoses for Talula

  • Schizotypal Personality Disorder
  • Schizophrenia
  • Bipolar disorder 1
• Reliability


  The extent to which psychiatrists can agree on the same diagnosis when independently assessing patients (for classification systems to be reliable, different diagnosticians using same system should arrive at the same diagnosis).
• Research suggests there are significant cultural variations when diagnosing schizophrenia. i.e culture has an influence on the diagnostic process. Culture bias concerns the tendency to over-diagnose members of other cultures as suffering from schizophrenia. Most British psychiatrists are white and so there may be prejudice and stereotyping occurring, coupled with the wider issue of culturally accepted understandings of what mental illness really is.
• Comorbidity


  The extent that two (or more) conditions co-occur. Psychiatric co-morbidities are common amongst patients with schizophrenia, including substance abuse (47%), anxiety/panic disorder (15%), and symptoms of depression (50%).
• Validity of diagnosis


  A diagnosis is only valid if (for example) a schizophrenic patient is actually diagnosed with schizophrenia. If they are diagnosed with another disorder (e.g. depression) or if a person without schizophrenia is diagnosed as having the disorder, then neither of those diagnoses are valid.
• Many of the symptoms of schizophrenia are also found in many other disorders, such as depression and bipolar disorder. This problem is referred to as symptom overlap.
• There is some disagreement between psychologists over the gender prevalence rate of schizophrenia. The accepted belief was that males and females were equally vulnerable to the disorder. However, since the 1980s men have been diagnosed with schizophrenia more frequently than women.
• Criticisms of psychiatric classification

  • Rigid system and classification
  • Removing control from the patient, who can then be manipulated for social or political purposes
  • Validity and reliability of diagnosis
  • 69% of the panel working on the new DSM-5 had links with the pharmaceutical industry
• There is symptom overlap between schizophrenia and bipolar disorder, where a patient diagnosed with one could also receive a diagnosis of the other
• There is a gender bias in the diagnosis of schizophrenia, with men being diagnosed more frequently than women since the 1980s
• Clinicians often fail to consider that males tend to suffer more negative symptoms than women and have higher levels of substance abuse, and that females have better recovery rates and lower relapse rates
• Criticisms of psychiatric diagnosis

  • Rigid system and classification
  • Removing control from the patient, who can then be manipulated for social or political purposes
  • Validity and reliability of diagnosis
  • 69% of the panel working on the new DSM-5 had links with the pharmaceutical industry
• Labelling theory


  Looks at how self identity and behaviour may be determined or influenced by the terms/labels used to classify them
• Label is given by a psychiatrist (person in power)

  Patient becomes stripped of their old identity and the new one (the label) is assigned
• Label becomes internalised


  Patient takes on behaviours associated with the label
• Stigma


  Negative associations with labels of any mental illness - judgement / fear / discrimination
• Consequences of stigma for people with mental health problems

  • Less likely to find work/get promoted
  • Be in a steady long-term relationship
  • Live in decent housing
  • Be socially included in mainstream society
• Many believe that those with mental health problems are violent and unpredictable
• Stigma is made worse by media and how it portrays mental health