Part 2

• The medical model views mental health disorders as a biological malfunction or disruption. suggests mental health disorders can be understood and treated the same as physical illness, so treatments focus on correcting or reducing effects of malfunctions or disruptions in our biology.
• three aspects to explain mental illness:

  biochemistry

  genetics

  brain structure
• The biochemical explanation: abnormal levels of neurotransmitters
• Dopamine hypothesis (original)

  Patients with schizophrenia produce excessive amounts of dopamine, so too much is released into the synapses. This excess is responsible for the symptoms the patient would experience, e.g. hallucinations.
• Dopamine hypothesis (original) - positive symptoms

  Too much dopamine = positive symptoms due to too much activity
• Dopamine hypothesis (original) - negative symptoms

  Too little dopamine = negative symptoms due to reduced activity
• Dopamine hypothesis (revised)


  An excess of dopamine receptors on the post synaptic neurone is responsible for schizophrenia. These receptors are highly sensitive to dopamine and therefore more dopamine received and absorbed, increasing the amount of dopamine being made available and used.
• Brain abnormality:

  brain structure and function differences between people with mental illness and those without
• Brain abnormality as explanation for SZ:

  Enlarged ventricles - twins with SZ have larger ventricles that twins without SZ

  Reduced brain size - people with SZ have smaller brains compared to people without SZ

  reduced grey matter = longer person had SZ for.
• The genetic explanation of mental illness:

  direct relatives of people that have mental health have an increased likelihood of devolving mental illness, compared to those without mental illness. = genetic predisposition
• Genotype = total genetic makeup of an individual
• monozygotic = identical twins

  Dizygotic = non-identical twins.
• Concordance rate = the level of similarity between two people

  Parents and siblings = 50%

  Aunts and grandparents = 25%

  MZ = share 100% of genes

  DZ = share 50% of genes

  Other factors , like environment, play a part as percentage is not 100%.
• Genetic explanation of SZ

  Genetic influence rather than a genetic cause.

  If one identical twin has SZ, the other has a 46-53% chance of developing disorder.

  IF DZ, only 15% chance.
• Gottesman:

  Aim = to build on previous research into the likelihood of developing severe mental health disorders when one or both parents experience them.

  How vulnerable offspring were to developing any form of mental health disorder when one or both their parents were suffering from SZ or bi-polar.
• Gottesman-participants:

  2.6 million people

  Born in denmark

  alive in 1968 or born later

  link to their mother or father were established from the Civil Registration system

  
  

  196 couples both diagnosed with SZ and 270 of their children

  83 couples both diagnosed with bi-polar and their 146 children

  8006 couples one had SZ and their 13,878 children

  11995 couples one had bipolar and their 23512 children
• Gottesman-Method

  natural experiment

  IV= type of mental disorder

  DV= rate of diagnosis in their children
• Gottesman- procedure

  when someone born in denmark, they are allocated a unique identification number and data is stored and collected:

  Date of birth

  Sex

  Vital status

  Identity of parents/Siblings
• Gottesman-results

  -196 couples both with SZ = risk of children developing was 27.3%

  -8006 couple one with SZ = risk of children developing was 7% (0.86% if neither parent had SZ)

  -83 couples both had bipolar = risk of children developing was 24.9%

  -11,995 couples one had bipolar = risk of children developing was 4.4% (0.48 if neither parent had bipolar)

  
  

  if one parent had SZ and the other bipolar, the risk of their child developing SZ was 15.6% and bipolar was 11.7%.

  for general population, there was a 1 in 7 chance of developing either.
• Gottesman-conclusion

  if both parents had a severe mental illness, there was a far higher likelihood of developing the disorder, or a related disorder, which supports a hereditary, genetic link in the development of severe mental health disorders.
• Summarise how Gottesman's study links to the genetic explanation of mental illness:

  shows genetics have a role in explaining mental illness, specifically a genetic link between parents and offspring.

  found an increased risk of developing a disorder if parents had the mental disorder.

  7% risk of children developing SZ if one parent had compared to 0.86% if neither parent had.
• Strengths of Gottesman:

  quantitative data - compare and analyse

  Quasi experiment - high ecological validity

  Ethics - all public info given

  standardised

  large sample size and both genders

  high face validity -SZ and bipolar
• Weaknesses of Gottesman:

  quantitative data - lack detail

  quasi - low control

  no right to withdraw and no protection of participants

  low face validity - only two disorders studied

  ethnocentric - denmark
• What does Gottesman tell us about:

  Individual diversity = individual genetics, identical twins have a higher concordance rate compared to non-identical twins

  Social diversity = concordance rates are not 100% so other factors must influence mental health along with genetics

  cultural diversity = only danish participants considered, supporting the western view of mental illness but genetics are universal.
• Strengths of the medical model of mental illness:

  useful - increase understanding of mental health causing practical applications

  scientific - experimental proof with quantitative findings

  high face validity

  holistic - 3 parts including genetics + biochemical

  innate biology unique to each person
• Weaknesses of The medical model:

  doesn't represent external influences

  unscientific - human error, no cause and effect explanations, natural explanation

  individual difference - low face validity

  reductionist
• Biological treatments of SZ: drugs

  *Two types= Typical - Haloperidol - reduce positive symptoms

  Atypical - olanzopine - reduce both positive and negative symptoms

  *How they work= block dopamine receptors by fitting into the receptor space reserved for dopamine, reduce positive and negative symptoms

  *positives= reduce symptoms, reduce hospital admissions, reduce other medicine taken

  *negatives= side effects (sedation)
• The cognitive explanation of mental illness:

  faulty internal mental processes e.g faulty thinking processes and faulty attention

  errors in thinking

  overgeneralisation - person applies something from one event to all events.

  attentional bias - people pay attention to specific negative aspects of a situation and ignore other useful parts

  Example = spiders
• The psychodynamic explanation of mental illness:

  mental illness caused by unconscious processes and childhood experiences

  behaviour is a result of interaction between id, ego and superego.

  defence mechanisms help the ego to resolve the conflict, which is causing the anxiety.

  true feelings of anxiety are displaced on a less threatening object, like Freud displacing fear of his father on horses.
• The behaviourist explanation of mental illness:

  behaviour is learnt through our environment, via a process of conditioning

  an individual has learnt to develop a mental illness

  classical conditioning - learn behaviours through association

  operant conditioning - behaviour is learnt through reinforcement and punishment

  Phobias - individuals associate an object with fear and anxiety - Little Albert associated the white rat with the loud noise
• Non-biological treatment to treat phobias:

  systematic desensatisation

  remove the fear response and replace with the relaxed response

  taught muscle relaxation, creates a fear hierarchy and works their way up the list.

  repeatedly imagines the fear until it creates no fear and then move up a stage
• Strengths of systematic desensitisation:

  effective - high success rate

  long-lasting

  easy access

  weaknesses of systematic desensitisation:

  unethical - can make it worse

  time consuming - a lot of sessions

  doesn't treat all phobias
• Szasz:

  Aims - challenge medical concept of mental illness, reject the psychiatric treatments that are justified through medical model, stop using terms such as 'mental illnesses' and 'psychoses' and think of individual behaviours instead, reject the image of patients being helpless and having no control.

  Research method - article, reviewing changes in the beliefs and concepts surrounding mental health.
• How Szasz explains mental health:

  dislikes medical model

  if has a physical basis, then the disorder should be diagnosed as a physical illness and not a mental illness

  disturbing behaviours should be explained psychologically because there are psychological symptoms.

  mental illness is a myth and treatments are not needed, as illnesses are part of our behaviour.
• Positives of Szasz's view:

  provide alternative view

  promote individual differences and choice of treatments

  encourage other explanations

  shouldn't force drugs

  raised questions others hadn't
• Negative's of Szasz's research:

  Overstated and misinterpreted

  lack evidence

  subjective and biased

  doesn't support biological explanation
• what does Szasz's research tell us about:

  individual diversity - display different behaviours as a way to cope with their suffering and life problems

  social diversity - society medicalise behaviour that is not normal, social treatments preferable to medical intervention

  cultural diversity - western culture medicalises behaviour.