Background Key Concepts

• What is the supernatural explanation of mental health?

  Aetiology:

  • Abnormal behaviour is attributed to demonic possession and witchcraft
  • Mental illness is a punishment for wrongdoing - view shared by Hebrews, Ancient Egyptians and Early Chinese

  Treatment:

  • Saying prayers and immersing individual in holy water
  • Exorcisms - trephining, stretching, starving etc
• What is the aetiology for the Humoral explanation of mental health?

  • Hippocrates argued mental illness is caused by physiology
  • Caused by 4 bodily humours being imbalanced black bile, yellow bile, blood and phlegm
  • Excess of yellow bile leads to mania
  • Excess of black bile leads to depression
  • Led to Hippocratic Oath that doctors still take
• What are the treatments for the Humoral explanation of mental health?

  • Each fluid relates to personality:
  • Yellow bile - impulsive, ambitious, restless
  • Black bile - quiet, introverted, serious
  • Blood - courageous
  • Phlegm - calm
  • Black bile treated with laxative
  • Blood treated with bloodletting - leaches drain blood
  • Treated with changes to lifestyle e.g. diet
  • Recognised mental illness should not be stigmatised
  • Understanding physiological remedies could be used
• What is the Psychogenic Approach to explaining mental health?

  Aetiology:

  • Mental illness attributed to psychological factors
  • Freud suggested mental illness due to unconscious processes in the brain

  Treatment:

  • Freudian Psychoanalysis to gain insight into past and thoughts in subconscious
  • Used method of free association where patient expresses thoughts exactly as they occur
  • Also used dream analysis where unconscious thoughts are expressed in dreams
  • Psychoanalysis is dominant in early 1900s - led to many types of talking therapies (psychotherapy)
• What is the aetiology of the Somatogenic Approach explaining mental health?

  • Mental illness due to biological dysfunction and more popular with improved methods of studying brain
  • Explained in terms of abnormal brain structure and levels of neurotransmitters and inherited genes
  • Medical model as psychological problems linked to physical causes
  • Dominant view of mental illness in 20th century
• What are the treatments from the Somatogenic approach for mental health?

  • Electroconvulsive therapy (electrical currents through brain)
  • Psychosurgery (removing parts of brain through lobotomy)
  • Psychopharmacology (drugs)
  • Drug treatments are the dominant somatogenic treatment as mental illness largely caused by neurochemical dysfunction
  • Controlling symptoms through drugs made care in the community possible - patients live at home or in facilities whilst receiving treatment that keep disorder under control
• What 4 definitions did Rosenhan and Seligman suggest that would define abnormality?

  • Statistical infrequency
  • Deviation from social norms
  • Failure to function adequately
  • Deviation from ideal mental health
• How does deviation from social norms define abnormality?

  • Society's view on how we ought to act
  • Standards of acceptable behaviour are set by the social group and adhered to by those in it
  • Abnormality depends on age, gender, culture and situational and historical context
• What are the evaluations of deviation from social norms in defining abnormality?

  • Definition distinguishes between desirable and undesirable behaviour
  • Common disorders like depression that are not statistically infrequent would be considered abnormal as society agrees that symptoms are not how we ought to act
  • Those who do not live according to other's expectations can be branded abnormal
• How does failure to function adequately define abnormality?

  • Not being able to cope with everyday living such as keeping up with hygiene, jobs and participating in other activities
  • Not functioning adequately causes distress and suffering and this behaviour may cause distress for others who are taking care of the individual
• What are the evaluations of failure to function adequately in defining abnormality?

  • Fits with what many people consider abnormal
  • Recognises the subjective experience of the patient allowing us to view mental illness from the pov of the person experiencing it
  • Easy to judge objectively as clinicians can list clearly identifiable behaviours
  • Approach is related to cultural ideas on how life should be lived which leads to different diagnoses
  • Individuals can change dysfunctional behaviour and be adaptive and functional
• What did Jahoda define ideal mental health as and how does deviation from ideal mental health define abnormality?

  • Autonomy - coping alone
  • Self attitudes - high self esteem
  • Self actualisation - developing full potential
  • Integration - coping in stressful situations
  • Accurate perception of reality
  • Mastery of environment
  • Deviation from ideal mental health proposes that the absence of any of the criteria indicate abnormality
• What are the evaluations of deviation from ideal mental health?

  • Jahoda set out to think of mental health instead of mental illness so most of us are abnormal
  • Presented as ideal criteria so most of us do not fulfil them all the time
  • Criteria are difficult to measure so not useful or reliable in defining abnormality
  • Can be culturally biased
• How does statistical infrequency define abnormality?

  • Abnormality is a deviation from a statistically determined norm
  • Behaviours that occur infrequently are classed as abnormal
  • In mental health the normal distribution does not apply and has a positive skew e.g. some small numbers of people have many symptoms and some people will have none

  
• What are the evaluations of statistical infrequency?

  • Some statistically abnormal behaviours are desirable such as an extremely low depression score
  • Some statistically normal behaviours are undesirable such as many people experiencing depression symptoms
• What did Kraepelin categorise mental health disorders into?

  • Kraepelin first to categorise mental health disorders:
  • Psychoses - disorders were patient loses touch with reality - hallucination and delusion
  • Neuroses - disorders involving anxiety and disturbance
• What are strengths of using a classification system for mental health?

  • Provides common means for clinicians to communicate about patients
  • Aim to provide diagnosis to provide treatment
• How are mental health conditions diagnosed?

  • Clinicians follow a similar procedure
  • Check symptoms in an objective manner and check which disorder best fits those symptoms
  • Explains why referred to mental illness as treated in same way as physical and referred to as medical model
• What is the ICD-10?

  • International Classification of Diseases and Relates Health problems
  • Produced by WHO
  • Has both physical and mental disorders
  • Chapter V relates to mental disorders under title “Mental and Behavioural Disorders (F00-F99)
  • 11 sub categories
  • F30-F39 - mood affective disorders
  • F20-F29 - Schizophrenia and delusional disorders
• What is the DSM-V?

  • Diagnostic and Statistical Manual of Mental Disorders
  • Only contains mental illnesses
  • Had many changes
  • Used more in USA however more used in research studies as a standardised measure
  • Sub types of schizophrenia and autism removed
• What was the old multi axial approach in the DSM-V which is no longer used?

  Axis I - principal disorder

  Axis II - personality disorders

  Axis III - medical or neurological problems

  Axis IV - major psychological stressors e.g divorce

  Axis V - “level of function” on scale of 0-100 with 100 being “nearly perfect”
• What 3 sections is the DSM-V divided into which are now used instead of the multi axial approach?

  1 - introduces new style of DSM and describing how to do the process

  2 - 20 categories of disorders

  3 - provides assessment tools taking into account other cultures and disorders that exist but need more research
• Compare the ICD-10 and DSM-V:

  Similarities:

  • Changes made over time
  • Both holistic

  Differences:

  • ICD contains both physical and mental disorders whereas DSM-V contains only mental disorders
  • ICD used mostly in Europe and DSM-V mostly used in America as made by APA
  • ICD ethnocentric and new DSM-V not ethnocentric as assessment tools take into account cultural differences