historical context only

• 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 a 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
• 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 infrequency


  • 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
• problems with deviation from social norms


  • each culture will vary in what things are seen as normal behaviours
  • what counts as normal also changes over time
  • some people may dress differently or act in a way that is against the social norm out of choice
• problems with deviation for ideal mental health


  • most people would not meet all the criteria of ideal mental health
  • someone may be happy but not always act independently
  • you may find it difficult to cope with stressful situations at some point in your life but does that mean you are abnormal/mentally ill?
  • if you fall out with a person you were close to, does that count as abnormal?
• categorising mental disorders: DSM-5


  • the diagnostic and statistical manual is now in its fifth version, it is used in the USA
  • it tries to place disorders in chronological 'lifespan' order
  • wishing this broadly chronological approach, it also clusters disorders together to mirror clinical reality (e.g. internalising and externalising disorders)
  • dysfunctional behaviour are organised into 22 categories
  • for each disorder, DSM-5 includes details on the following: diagnostic criteria, gender-related diagnostic issues and culture-related diagnostic issues
• Rosenhan's aim


  to see if mental hospitals in the USA in the early 1970s could tell the sane from the insane
• (Rosenhan) Study 1, entering the mental hospitals


  • 8 sane people phoned up for an appointment at 12 different mental hospitals
  • when they arrived at admissions, they all reported the same symptoms (of hearing an unfamiliar voice of the same sex saying 'empty', 'hollow' and 'thud') they all gave false names
  • once admitted they stopped simulating any symptoms, all the time writing notes about ward staff and patients
  • on all occasions, the pseudo patients were admitted- once with a diagnosis of manic-depressive psychosis, all other times with a diagnosis of schizophrenia
• (Rosenhan) Study 1, in the mental hospitals

  • they remained in hospital for 7-52 days (an average of 19 days)
  • when they were discharged, it was with a diagnosis of schizophrenia 'in remission'
  • although their sanity was to detected by staff 35/118 patients voiced their suspicions
  • researchers' normal behaviours were misinterpreted
  • they saw some of the ward orderlies being brutal to patients in full view of other patients
  • attendants spent only 11.3% of their shifts outside their office
  • total time patient spent with psychologist was 6.8 minutes a day
• (Rosenhan) the experiment within study 1

  • in 4 of the hospitals, the pseudo patients approached a staff member with a simple polite request
  • they recorded how staff responded to this request (moved on with head averted, made eye contact, paused and chatted or stopped and talked)
  • a comparison study was done at Stanford, with a young female approaching a member of staff who looked busy and asking them 6 questions
• (Rosenhan) findings from the experiment within study 1

  • the experiment was attempted on psychiatrists 185 times and 1283 times on nurses and attendants
  • 71% of times the psychiatrists moved on, head averted and 88% for nurses and attendants
  • 4% of psychiatrists stopped and talked, 0.5% of nurses and attendants stopped and talked
• (Rosenhan) Study 2


  • a teaching and research hospital that was aware of the first study was informed that during the next three months one or more pseudopatients would attempt to be admitted into the hospital
  • each member of staff was asked to rate on a 10 point scale each new patients as to the likelihood of being a pseudopatient but to treat everyone as a real patient
  • in practice, no pseudopatients attempted to be admitted during this period, so the staff were rating their regular intake
• Rosenhan conclusions


  • mental hospitals in the US in the 70s were not very good at making valid diagnoses (failure to identify both sanity and insanity)
  • they are not very good at making reliable diagnoses, all pseudopatients did not receive the same diagnoses
  • they tended to view all behaviours as reflecting the diagnosis a patient had been given
  • patients in mental hospitals in the US in the 70s were often treated with profound disrespect
• characteristics of an affective disorder (depression)

  1. depressed mood most of the day, nearly every day
  2. diminished interest or pleasure in all activities
  3. body weights loss of more than 5% not due to diet
  4. insomnia or excessive sleep nearly every day
  5. restlessness or less activity nearly every day
  6. fatigue or loss of energy nearly every day
  7. feelings of worthlessness or guilt nearly every day
  8. lack of ability to think, concentrate or make decisions
  9. recurrent thoughts of death or suicide

  there should be five or more of these symptoms within 2 weeks
• characteristics of a psychotic disorder (schizophrenia)

  1. delusions
  2. hallucinations
  3. disorganised speech
  4. grossly disorganised or catatonic behaviour
  5. negative symptoms (lack of expression)

  schizophrenia is a psychotic disorder that typically emerges in late teens and mid 30s. for diagnosis two or more of the following must be present for a significant portion of time during a 1 month period
• characteristics of an anxiety disorder (phobias)

  a phobia is a strong, persistent and irrational fear of, and desire to avoid, a particular object, activity or situation. there are three types of phobias:

  • specific phobia- extreme fear of a specific object
  • agoraphobia- fear of open spaces, but it typical involves the fear of being in situations from which escape may be difficult
  • social phobia- this is an intense and excessive fear of being in a situation in which one is exposed to possible scrutiny by others

  the majority of people with social phobia and agoraphobia are female
• strengths of listed characteristics during diagnosis

  • clear criteria should lead to a more reliable and accurate diagnosis
  • DSM could be seen as a more scientific way of classifying disorders than other definitions
  • diagnostic criteria take account of the fact that there may be other causes for the symptoms
• weaknesses of listed characteristics during diagnosis

  • issues in terms of how the doctor assesses the patient through observing their behaviour or relying on self-report from patient and/or family members which may be biased and therefore lacks validity
  • people may not show all the symptoms or have not shown them for long enough to be given a diagnosis and so cannot receive treatment
  • people may show symptoms of more than one illness and therefore it would be difficult to know how to make the diagnosis