Topic 1- historical context

• historical views of 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 psych 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 in relation to ethnocentrism


  • different cultures have different social norms, as such, that it 'abnormal' in one culture may not be abnormal elsewhere. for example hearing voices may be totally acceptable in some cultures as part of religious practices.
  • frequency of behaviour will differ between cultures
• defining abnormality in relation to usefulness 


  • a bit too wide-ranging to be of.practical use and includes things that are not dysfunctional
  • however, it can be useful as a first step towards the more specific kinds of categorising done in DSM
• defining abnormality in relation to reliability


  • deviation from social norms- social norms change over time and depending on the social group
  • function adequately could be subjective
  • by setting a cut-off statistical infrequency could be a consistent way of defining abnormality
• defining abnormality in relation to validity

  counts things as abnormal that are not

  • genius or high-level artistic or sporting ability are rare: does this make them 'abnormal'?
  • children do not hold down jobs or look after themselves: are they 'abnormal'?
  • ideas about functioning adequately are subjective and could be explained by other factors
• DSM-5 in relation to ethnocentrism


  • DSM-5 is produced by the American Psychiatric Association, while other diagnostic manuals are used in Europe and China- so diagnosis might be different
  • however, the inclusion of 'culture-related diagnostic issues' is an explicit attempt to recognise that that may be deemed as a disorder in one culture may be seen as entirely normal elsewhere
• DSM-5 in relation to usefulness


  • DSM-5 is used by clinical psychologists to help them diagnose disorders; this then opens the door to treatments
  • but risks of over diagnosis with the need to classify normal behaviours. labelling people as mentally ill can cause more harm than good
• DSM-5 in relation to reliability


  • having lists of symptoms for each disorder (including how many need to be shown and how long for) should help clinicians to be consistent with one another in their diagnoses
• DSM-5 is relation to validity

  • diagnoses can often rely on self-reported symptoms, can we rely on these?
  • there can be misdiagnosis (arising from overlap of symptoms between disorders)
  • what counts as a disorder may reflect the values of a particular period of time rather than anything about the individual (homosexuality was once considered a disorder)
• Rosenhan's study in relation to ethnocentrism


  • it only tells us about mental hospitals in the USA- it may be that in mental hospitals elsewhere, staff were much better at diagnosing mental disorders accurately and with consistency
• Rosenhan's study in relation to ethical considerations

  • the hospitals in study 1 did not consent to take part, and the staff and patients being studied could not withdraw from being observed
  • arguable, the pseudopatients may have caused harm by taking up valuable time
  • in study 2, the hospital was deceived as Rosenhan did not send along any pseudopatients.
  • at least the identity of the hospitals was kept confidential and so were protected from harm
• Rosenhan's study in relation to validity

  • the diagnoses that were made were inaccurate, study 1 pseudopatients did not suffer from any kind of mental disorder, study 2 most of the real patents being assessed did have disorders
  • because the diagnoses were inaccurate, they were invalid
  • as a naturalistic observation done 'in the field', the study itself is ecologically valid
• Rosenhan's study in relation to reliability

  • there was a large degree of consistency between clinicians in there diagnosis in study 1 (11/12 pseudopatients diagnosed with schizophrenia); however, the fact that on one occasion the same symptoms were given a diagnosis of manic-depressive psychosis suggests an issue with reliability
  • potential issues of consistency in how pseudopatients behaved
• Rosenhan's study in relation to usefulness


  • the study was hugely valuable in highlighting a need for DSM-2 to be revised. when DSM-3 was published in 1980, it contained clearer diagnostic criteria for disorders
  • the study also highlighted a need for staff to be trained in how to treat patients in their care with respect
• Rosenhan's study in relation to individual vs situational


  • the comparison studies suggested that the situation in which a person makes a request influences how that request is responded to
• characteristics of disorders in relation to reliability

  • the characteristics should be reliable in the sense that the criteria are clearly defined (so they can be applied more consistently in identifying whether someone is suffering from a mental disorder
  • still to some extent subjective as to whether someone has the symptoms or not- some symptoms are seen in multiple disorders so there could be some inconsistencies
• characteristics of disorders in relation to social sensitivity

  • idea of labelling someone as having a mental disorder could be an issue as there is still a social stigma around mental illness which means the person could be treated differently or discriminated against
  • however, diagnosis is vital in being able to ensure the patient is protected from causing harm to themselves or others
• characteristics of disorders in relation to ethnocentrism

  • different diagnosis tools are used in different countries which might list different criteria for making judgements
  • cultural norms in different countries are different so certain behaviours may not be seen as signs of mental illness. also, there are cultural differences in how people express emotions
• characteristics of disorders in relation to usefulness

  • useful for identifying disorders as it should be morel likely to lead to an accurate diagnosis if they have a list of symptoms that must be met which could lead to effective treatment
  • however, it would be less useful if the patient is mis-diagnosed