Topic one - application

• Characteristics of depression

  1. Depressed mood for most of the day
  2. Diminished interest or pleasure in all or most activities most of the day
  3. Body weight loss of more than 5% not due to diet or change in appetite
  4. Insomnia or excessive sleep nearly every day
  5. Fatigue or loss of energy nearly every day
  6. Recurring thoughts of death or suicide, or suicide attempt

  And more
• Characteristics of schizophrenia

  1. Thought echo, thought insertion or withdrawal, and thought broadcasting
  2. Delusion of control, influence or passivity clearly referred to body or limb movements or specific thoughts, actions or sensations; delusional perception
  3. Hallucinatory voices giving a running commentary of the patients behaviour
  4. persistent delusions of other kinds that are culturally inappropriate and completely impossible such as superhuman powers & abilities
• Characteristics of phobias

  1. Fear of using public transport, being in open spaces, being in enclosed spaces, standing in line or in a crowd, being outside of home alone
  2. Categorised into specific phobias, agoraphobias and social phobias
  3. Must go on for six months or more, be persistent, disrupt normal life ect
• DSM-5

  • Diagnostic and Statistical Manual of Mental Disorders
  • Comprised of a set of symptoms people must demonstrate in order to get a diagnosis
  • DSM-5 is the newest version of the DSM
• Strengths of DSM-5

  • Clear criteria's so should lead to a more reliable way of classifying disorders than other definitions
  • Diagnostic criteria take into account of the fact that there may be other causes for the symptoms (e.g. substance use et)
• Weakness of DSM-5

  • Issues in terms of how the doctor actually assesses the patient through observing their behaviour or relying on self-report from patient and/or family members (which may look subjective and therefore lacks validity)
  • People may not show all the symptoms or have not shown them for long enough to get a diagnosis and therefore can't get treatment
• Weaknesses of DSM-5

  • People may show symptoms of more than one illness and therefore it would be difficult to know how to make a diagnosis
  • There may still be other reasons for the symptoms that have not been considered.
• Reliability

  • Affective (depression) - some criteria may be quite clear e.g. depressed mood most of the day, major sleep disruption but self-report is needed and professionals may vary in how they look for other causes before they diagnose.
  • Anxiety - certainly simple phobias may be easier to see e.g. the fight/flight reaction although agoraphobia may be a sign of other generable social anxiety problems
  • Psychotic - being quite severe these could be easier to spot and less reliant on self report (may also be seen by others0
• Socially sensitive

  • All could be seen as being potentially socially sensitive as demonstrated by Rosenhand labels stick with people. Schizophrenia perhaps is the most significant in terms of how people are perceived and potentially treated.
  • Also - genetic transmission - people may discourage people with these disorders from having children.
• Ethnocentrism

  • For all disorders cultural norms may make a diagnosis more or less likely as will potential access to treatment and diagnosis itself
  • Hearing voices in some cultures can be seen as ancestors speaking to you, or as some religious experiences
• Usefulness

  • Useful for identifying disorders as it should be more likely to lead to an accurate diagnosis if they have a list of synonyms that must be met which could lead to effective treatments (although it does not tell the doctor which treatment would be most effective)
  • However it would be less useful if the patient is mis-diagnosed.
• Rosenhan

  • Conducted a study in the USA to assess whether hospitals could tell the sane from the insane
  • Convinced 8 people to be pseudo-patients
  • They would contact a hospital for an appointment and report hearing a voice saying 'empty', 'hollow' and 'thud'
  • 12 hospitals tested from 5 states - 11 were state or university funded and one was private - all of differing places in location and ratings
• Rosenhan procedure

  • Once admitted pseudo-patients were to act normally and make no mention of the symptom of hearing a voice
  • Would do everything they were asked to by staff
  • Make notes on what happened - the participants in the study were the real patients and the staff at the hospitals
  • Could only leave if they were discharged by the hospital
• Rosenhan results

  • 11 hospitals gave the diagnosis of schizophrenia and released the person with a diagnosis of schizophrenia in remission
  • The other had a diagnosis of manic depression
  • They spent an average of 19 days in hospital, with a range from 7 to 52 days
  • Pseudo-patients were never discovered as fake by staff
  • Some of the real patients questions them and suspected them as fake - some questioned if they were journalists
• Rosenhan experience inside of the hospital

  • Staff had minimal contact with the patients - rare for them to talk to them or play a game with them
  • Staff spent 11.3% of their shift time outside of their workroom ('cage')
  • Number of times they left their workroom ranged from 4-41 with an average of 11.5 times for a day shit (9.4 for late or night shift average)
• Rosenhan experience inside of the hospital pt.2

  • Doctors, especially psychiatrists were hardly seen - leave office average of 6.7 times a day
  • The average amount of time for a patient to spend with staff ranged from 3.9 to 25.1 minutes. Average 6.8 minutes per day over the total of 129 days, including the admissions interview, ward meetings, case conferences and discharge meetings.
• Rosenhan - depersonalisation and powerlessness

  • Patients had lost many legal rights - couldn't initiate with staff, staff ignored them and often walked straight past them
  • No privacy of their possessions or case notes - could be seen and read by anyone
  • Patients often monitored during both toilet visits - sometimes no doors on toilets
• Rosenhan - depersonalisation and powerlessness pt 2

  • Physical examinations took place in semi-public places with other staff members there
  • Staff not caring if patients did or didn't take their medications (as long as they behaved) - pseudo-patients would flush theirs down the toilet and found others in there did the same
• Stickiness of labels - Rosenhan

  • Patients case histories were interpreted by the label they were given
  • A normal background outlining relationships with parents growing up would be noted in a very different way with suggestions of issues which aren't true
• Stickiness of labels - Rosenhan

  • Behaviours were interpreted as being an aspect of their disorder
  • Making notes is seen as a behavioural manifestation of their disorder
  • Pacing corridors (due to boredom) was seen as nervousness
  • Waiting outside the dinging hall half an hour before lunch is seen as oral acquisitive behaviour
• Follow-up study - Rosenhan

  • Staff at a teaching and research hospital highly doubted Rosenhan's findings, so he set up a study to test them. They were told that during the next three months, one or more pseudo-patients would try to get admitted
  • Staff were told to rate each person on how likely they were to be a pseudo-patient, but to treat everyone as if they were a real patient. Rated each person on a 10 point scale, where 1-2 reflected high confidence of the patient as a pseudo-patient
• Follow-up study pt 2

  • For the 193 patients admitted, at least one staff member rater 41 of them as a pseudo-patient, 23 were rated as a pseudo-patient by at least one psychiatrist and 19 by a psychiatrist plus one other member of staff
  • None were actually sent - so they were judging sick people as likely to be healthy
• Ethnocentrism - Rosenhan

  • May not reflect they way patients are treated in other cultures where there may be more or less stigma about mental disorders
  • Other cultures may place more emphasis of other types of treatment (other than medicine)
• Ethical considerations - Rosenhan

  • Experiment 2 was ethical in that the hospital staff were told to treat all people who were admitted as if they were a real patient
  • However, there was a lack of consent given by the hospital staff and they were deceived into thinking the people they were admitting heard voices (exp. 1) and that some people trying to be admitted were pseudo-patients (exp. 2)
  • The procedure would have been distressing for the pseudo-patients as they could not escape the situation or convince the staff they were sane.
• Validity - Rosenhan

  • High in ecological validity as they were in real institutions where staff and patients were unaware the pseudo-patients were fakes so their behaviour was natural
  • The results should be generalisable as the hospitals studied were from across the East and West coasts of the USA and ranged in size as well as being both state-funded and private
• Validity - Rosenhan pt 2

  • Pseudo-patients were not really experiencing mental illness so their experiences may not represent those of a real patient
  • The behaviour of the patients was interpreted in a subjective way by the staff and seen in terms of the label of schizophrenia they were given showing that the diagnosis at the time was invalid. The study showed that the criteria used for diagnosing schizophrenia can lead to incorrect diagnosis
• Reliability - Rosenhan

  • The study showed that the DSM criteria for schizophrenia are fairly reliable as 11/12 hospitals gave the same diagnosis (although the fact one hospital gave a different one suggests criteria is not completely consistent)
  • The fact that different people played the role of the pseudo-patient means there may have been inconsistencies in how they acted when in the hospitals (although they had been told to present normally the whole time
  • The findings are unlikely to be replicated now as the practices have changed and staff are given more training
• Usefulness - Rosenhan

  • The study was useful in suggesting issues in the way that patients in mental institutions are diagnosed and then treated
  • This led to changes in the DSM including a list of diagnostic criteria that need to be met before diagnosis is given (to make it more reliable and valid)
  • Rosenhan made suggestions about how to improve the process by educating staff ect. (not labelling, just treating the symptoms)
• Individual/situational - Rosenhan

  • Situational in that the label given to the patients affected the way that their behaviour was interpreted by staff at the hospitals and therefore how they were treated
  • A comparison study supports this as patients' requests were ignored and staff just walked past them without making eye contact
  • The hospital environment and behaviour of the staff led to feelings of depersonalization and powerlessness in patients.
• Individual/situational - Rosenhan pt 2

  • The way staff acted and treated patients (e.g. ignoring them, lack of contact) was an institutional practice possibly due to lack of training rather than to personality factors
  • Individual differences led one hospital psychiatrist to give a different diagnosis in experiment 1 for the same symptoms
• Background - supernatural explanation

  mental illness was believed to come from evil spirits taking control of an individual and controlling their behaviour . these spirits could be the spirits of ancestors, gods, heroes etc. treatments centred on creating holes (trepanes) in the possessed person's skull to let the evil spirits out
• Background - somatogenic explanation

  humourism- Hippocrates claimed that the human body is made up of four bodily humours: blood, phlegm, yellow bile and black bile. when the humours are properly balanced and mingled, a person will feel the most perfect health. however, illness happens when here is too much or too little of any one of the four humours. balancing of the humours could achieved through purging, bloodletting and diets
• background - based on somatogenic explanation

  animalism- mental illness was explained in terms of the individual losing the one thing that distinguishes us from animals, a capacity to reason. it is because people experiencing madness have lost this capacity that they exhibit disorder, unruliness and wildness. treatment focused on trying to restore reason and it was believed that this was best done through fear, so the insane were treated like animals.
• background - moral treatment


  in 1972, Philippe Pinel was made chief physician of an asylum. he suggested that mental illness was a result of psychological or social stress, congenital or physiological injury rather than demonic possession. patients should be treated in a humane way, interactions between doctors and patients should be friendly and doctors should keep detailed case histories to help with the treatment of patients
• historical views on mental illness in relation to ethics

  these earlier treatments often carried out against the person's wishes so there was a lack of consent and they could not withdraw from the treatment.

  • demonic possession- risks of infection and brain damage from trepanes.
  • humourism- risked of severely weakening patients, leaving them vulnerable to other illnesses
  • animalism- risk of physical harm and mental distress
  • moral treatment was much more ethical as an approach and called for patients to be treated humanely
• Historical views of mental illness in relation to individual/situational

  individual

  • animalism is individual, it is saying that their mental illness is the result of the person's inability to reason
  • humourism is individual, mental illness is the result of someone's humours being out of balance
  • moral treatment suggests that mental illness can result from congenital conditions or physiological injury

  situational

  • demonic possession attributes mental illness to evil spirits
  • moral treatment suggests mental illness can be a result of external factors such as social stress
• Historical views of mental illness in relation to psychology as a science

  • many of the treatments are unscientific as they are no based on objective evidence. it unlikely for mental illness to be caused by evil spirits
  • Hippocrates theory was a more scientific approach, it suggested there was a natural, physical cause of mental illness that can be treated like any other illness. but this is not scientific evidence for humours affecting behaviour
  • many of the theories are not falsifiable, they cannot be tested
  • moral treatment is more scientific as Pinel carried out an experiments to prove theories
• Defining abnormality

  • statistical infrequency- behaviour that is shown less often than the normal amount for that society, abnormal in the sense of being rare
  • failure to function adequately- centres on an inability to live a 'normal' life, such as holding down a job or interacting effectively in society
  • deviation from social norms- going against behaviours that are deemed by the society they live in to be 'normal' and 'acceptable'
  • deviation from ideal mental health- lack of positive self-image, growth and development, independent thought and interpersonal relationships
• problems with statistical infrequencey

  • just because a behaviour is rare, does that mean we should call it abnormal?
  • someone highly talented at something is not considered abnormal
  • how rare must a behaviour be to be considered/count as abnormal
• Problems with failure to function adequately

  • sometimes our ability to function in this way may be a result of other factors
  • people do not always look after themselves, they engage in risk taking behaviours, but this is not a sign of mental illness