- Created by: Georgia Kirk
- Created on: 28-11-18 14:17
Historical context of mental health
Historical views of mental health
Trepanning: Drilling holes in skull to let the 'demon out'
Prefrontal lobotomy: Used to reduce uncontrollably violent/ emotional people. Psychosurgery that destroys brain tissue- nerves that connect the frontal lobes to the parts of the brain that control emotions are severed. Patient shcoked into coma, then a tool put through eye-socket to cut nerves.
Deviation from social norms
Deviation from ideal mental health
Categorising mental health disorders
DSM-V. Particularly used in USA
ICD-10. Predominantly used in rest of the world
Rosenhan (1973)- Theory which study is based on
Benedict (1934)- suggested thaqt abnormality and normality aren't universal. What's seen as normal in one culture may be seen as aberrant in another.
Gross (2010)- Abnormality can be seen as any of:
deviation from the average, a deviation from the norm, a deviation from ideal mental health, personal distress, maladaptiveness, unexpected behaviour, highly unpredictable behaviour, mental illness.
Patients present symptoms that can implicitly be categorised. Sane distinguishable from insane.
Emil Kraepelin in 1886- developed first classification system- believing that like physical illnesses, mental disorders can be diagnosed by observable symptoms.
Rosenhan (1973)- Background
Research has shown that the reliability of early classification systems (e.g DSM) were very poor.
Beck et al (1962)- found that agreement on diagnosis for 153 patients (where each patient was assessed by 2 psychiatrists from a group of 4) was only 54%. Said to be due to the vague criteria for diagnosis and inconsistencies in the techniques used to gather data.
Szasz (1961), Grove (1970), Sarbin (1972)- show that the belief that symptoms can be easily categorised may be questioned.
to extend the efforts of previous reserachers who had submitted themselves to pychiatric hospitalisation but had commonly remained in hospitals for only a short amount of time.
to test the diagnostic system in use at the time (DSM-IV) to see whether valid and reliable. Get him and another 7 other individuals admitted to psychiatric hospitals.
to observe and report on the experience of being a patient in a psychiatric hospital
Rosenhan (1973)- Research method
Field experiment due to:
Independent variable- the 12 different hospitals
Dependent variable- the treatment and experience of the pseudopatients
Rosenhan (1973)- Procedure (Part A)
8 pseudopatients- Psychology graduate in his twenties, 3 psychologists, a paediatrician, a psychiatrist, a painter and a housewife.
Once in the hospitals, the pseudopatients became observers.
Part (a)- Fake names, fake occupations
Significant events of a patient's life history kept the same (e.g relationship with parents, siblings etc)
Frustrations, upsets described as well as joys, satisfactions.
Sought admission to 12 hospitals in USA- Pseudopatients called the hospital to arrange appointment, on arrival they reported they had been hearing voices, which were unclear, unfamiliar, of the same sex as themselves. Voices said 'hollow', 'thud', 'empty'.
Behaved normally when admitted, interacted with staff, patients.
Told staff they felt fine, no longer experienced symptoms.
Recorded observations of staff and patients in a notebook.
Had reponsability to convince staff that they were sane and therefore discharged
Rosenhan (1973)-Part B, C
Part (b)- In 4 of the hospitals- pseudopatients approached members of staff and asked 'Pardon me, Dr, could you tell me when I will be eligible for grounds privileges/ when am i likely to be discharged?'
Part (c)- Young lady approached individual faculty members at Stanford University whop seemed to be walking purposefully to some meeting and asked 1/6 questions. (e.g Do you teach here? Do you know where ... is?)
Part (d)- Staff at a research and teaching hospital who were aware of the findings of the fisrt study but doubted that such an error could occur in their hospital were warned that over the next 3 months 1 or more pseudopatients would present themselves. None actually did so.
Each staff member was askied to rate each patient who arrived at admissions according to the likelihood that they were the pseudopatient. A 10-point scale was used.
Rosenhan (1973)-Part A key findings
All pseudopatients were admitted to hospital, remained for 7-52 days.
7/8 pseudopatients diagnosed with schizophrenia, when discharged they left with the diagnosis of 'schizophrenia in remission'. Other pseudopatient was diagnosed with having manic-depressive psychosis.
No staff asked what the notes were- just assumed it was part of their illness, made comments in their records, such as 'engages in writing behaviour'. Behaviours misinterpreted (e.g pacing the coriridors through boredom was a sigb of anxiety, queuing early for lunch was observed as the oral-acquisitive nature of their syndrome)
If the patient became upset ot distressed by staff's behaviour, this was seen to be because of their illness, not due to the situation (a case of making dispositional not institutional attributions)
Real patients detected the pseudopatients' sanity 35/118 voiced their suspicions- 'you're not craz, you're a journalist. You're checking up on the hospital'
2,100 pills handed out to pseudopatients, all but 2 were flushed away.
Staff keep themselves away from patients
Suffered from a minimum of personal privacy and physical abuse by staff, which stopped when another member of staff appeared.
All experienced powerlessness and depersonalisation
Rosenhan (1973)- Part B, C, D key findings
Most common response- brief response offered whilst they were 'on the move', with head averted, or no response at all. Few staff made eye contact with the pseudopatients.
Students were talked to 100% of the time, whereas pseudopatients were talked to only
4% of the time by psychiatrists
0.5% by nurses
193 genuine patients- 41 were judged with high confidence to be pseudopatients by at least 1 member of staff
Psychiatric diagnosis is innacurate
Rosenhan claims 'we cannot distinguish sane from insane in psychiatric hospitals'
Behaviour is easily distorted, patients are treated in ways which perpetuate any problems, rather than being provided with support.
Patients experience powerlessness and depersonalisation.
Once a patient has been labelled 'insane', all subsequent behaviour is seen in the light of the label given.
Mental health workers are insensitive to the feelings of patients.
DSM-IV has poor reliability
The diagnosis of mental illness can be influenced by the situation an individual finds themselves in.
The medical model
The biochemical explanation for mental illness:
e.g the role of neurotransmitters, such as seratonin, dopamine, noradrenaline
The genetic explanation:
e.g the concept of genetic transmission of mental illness/ genetic vulnerability to mental illness
Brain abnormality as an explanation:
e.g in relation to depression, schizophrenia, bipolar the use of brain scanning techniques such as PET identify brain abnormalities
Gottesman (2010)- Theory which study is based on
Signs and symptoms of mentall illness can vary, depending on a particular disorder, circumstance.
Schizophrenia is severe, characterised by profound disruptions in thinking, affecting language, perception and the sense of self.
Includes psychotic experiencs, such as hearing voices or delusions.
Typically begins in late adolescense early adulthood.
Bipolar is a chronic episode illness associated with behavioural disturbances
Episodes of mania and depression
Gottesman (2010)- Background & Research method
Gottesman proposed that studies of the outcome in the ofspring of parents with homotypic disorder, may show that they also have been diagnosed with a mental disorder.
Suggesting that it is a genetic or hereditary basis for disorders.
The study aimed to build on previous research and in an attempt to have a large sample size, was conducted using all register-based diagnoses for each patient reported in the nationwide Danish Psychiatric Central Register.
National register-based cohort stufy in Denmark
Gottesman (2010)- Procedure
Sample- 2.6 million people sample. Born in Denmark, alive in 1968 or born later. Link with their mother and father.
Those who had ever recieved diagnoses of schizophrenia, bipolar, or unipolar depressive disorder were identified among a group of parent couples with both parents ever having been admitted to a psychiatric facility from 1970-2007.
For each of these groups of parent couples, their offspring, were checked in the register for admissions with similar/related diagnoses.
For comparison, cumulative incidences were also calculated in the offspring of couples with only one parent having been admitted to a psychiatric facility.
Cleaned population- neither parents having been admitted.
Uncleaned population- parent couples with no restrictions on parent diagnoses.
Parents and offspring were classified using ICD-8 or ICD-10.
Gottesman (2010)- Key findings
Both parents- 27.3%
1 parent- 7%
Neither parent- 0.86%
Both parents- 24.9%
1 parent- 4.4%
Neither parent- 0.48%
Gottesman (2010)- Conclusions & Application
Offspring of dual matings diagnosed with psychosis constitute super-high-risk sample of psychosis.
Highest risk of being admitted to a hospital if both parents have been admitted with the same diagnosis.
Biological treatment of one specific disorder, e.g depression- Antidepressant drugs such as MAOIs, SSRIs,
Electroconvulsive therapy (ECT)
Transcranial magnetic stimulation (TMS0
e.g schizophrenia- Antipsychotic drugs
Alternatives of the medical model
The behaviourist explanation-
How learning processes can be used to explain the origins of mental illness, e.g classical conditioning (Little Albert), operant conditioning, social learning theory.
The cognitive explanation-
How individuals with mental illness are considered faulty through processes,
e.g Beck- negative cognitive triad
Ellis- the link between irrational thoughts and mental illness
(a) The Humanist explanation- e.g Carl Rogers' theory involving the actualisinh tendency and the self-concept
Maslow's hierachy of needs
(b) The Psychodynamic explanation- e.g Freud's hydraulic model, the roles of id, ego and superefo.
(c) The Cognitive Neuroscience explanation- e.g the increasing use of brain-imaging techniques (MRI,PET) to investigate the relationship between cognitive function and brain function.