Psychology: The Historical Context of Mental Health

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  • Created by: Madisonxo
  • Created on: 20-03-19 23:25
Define abnormality 1
Deviation from social norms
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Define abonormality 2
Failure to function adequately
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Define abnormality 3
Deviation from ideal mental health (Jahoda's 6)
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Deviation from social norms
Social norms = explicit and implicit rules that society has about what are acceptable behaviours, beliefs and values. People who violate such norms are often regarded as abnormal.
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Limitations of the deviation from social norms definition of abnormality
Eccentric or abnormal? Context-specific behaviour? Change with time? Risk of abuse? Cultural issues?
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Eccentric or abnormal?
Deviation from social norms does not always indicate psychological abnormality
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Context-specific behaviour?
Behaviour is often context-specific, deviation from a social norm may be acceptable in one situation but not another.
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Change with time?
Beliefs about what is morally acceptable change over time. What's regarded as deviant by one generation is regarded as acceptable to another.
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Risk of abuse?
If we adhere strictly to the view that deviation equates to psychological abnormality there is a risk that those who deviate are labelled "mad" and treated accordingly. The definition can be used as a means of social control.
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Limitations of defining abnormality in terms of statistical infrequency?
Does not take into account desirability of behaviour (e.g. high IQ), no distinction between rare, odd and psychologically abnormal behaviour. Some psychologically abnormal behaviours are quite common.
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Failure to function adequately
People with psychological disorders often experience considerable suffering and distress and a general inability to cope with their everyday activities.
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Limitations of the failure to function adequately definition of abnormality
Not the whole picture, exceptions to the rule, direction of causality
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Not the whole picture? - Comer (2005)
Comer (2005) points out that psychological abnormality is not necessarily indicated by dysfunction alone.
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Exceptions to the rule?
E.g. a student experiencing anxiety about an exam may be behaving uncharacteristically and inadequately but this would not necessarily be regarded as abnormal behaviour.
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Direction of causality?
Cultural issues: It may be that the inability to cope with the demands of daily living is the cause rather than the outcome of mental disorder. E.g. stats show higher incidence of psychological problems among minority groups, owing to racism etc.
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Direction of causality: Cochrane and Sashidharan (1995)
Racism and prejudice have a signif impact upon psychological wellbeing.
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Failure to function adequately: criteria
1) dysfunctional behaviours 2) observer discomfort 3) unpredictable behaviour 4) irrational behaviour 5) personal distress
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1) dysfunctional behaviours?
Behaviour which goes against the accepted standards of behaviour.
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2) observer discomfort?
Behaviour that causes other individuals to become uncomfortable
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3) unpredictable behaviour?
Impulsive behaviour that seems to be uncontrollable
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4) irrational behaviour?
Behaviour that is unreasonable and illogical
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5) personal distress?
Being affected by emotion to an excessive degree.
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Limitations to the failure to function adequately definition of abnormality?
'function' and 'adequately' are undefined, depends on culture, sometimes the behaviour can be beneficial (e.g. someone may be willing to risk their life for someone else).
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Jahoda's 6
Positive attitudes towards self, self actualisation of ones potential, resistance to stress, personal autonomy, accurate perception of reality, adapting to and mastering environment
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Positive attitudes towards self?
Having a positive self-concept and a sense of identity (Self-confidence, self-respect, self-reliance, self-acceptance etc.)
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Self-actualisation of one's potential?
We all have potential and we that we constantly strive to fulfill this potential.
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Resistance to stress?
Ability to tolerate anxiety without disintegration e.g. using coping strategies for dealing with stressful situations.
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Personal autonomy?
Autonomous people are reliant on their own inner resources and can remain relatively stable even in the face of frustrations and deprivations because they are not dependent on others.
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Accurate perceptions of reality?
Seeing ones self and the world in realistic terms rather than in an overly pessimistic or overly optimistic manner.
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Adapting to and mastering the environment?
This means being competent in all areas of life (work, personal relationships and leisure activities etc) and being flexible and able to adjust to change.
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Limitations of the deviation from ideal mental health definition?
Self actualising: few achieve their full potential in life, possible benefits of stress, cultural issues: based on Western ideas of self-fulfillment, perceptions differ over time. subjective.
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Absolute abnormality
Occurring in the same way and frequency across cultures
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Universal abnormality
Present in all cultures, but not necessarily with the frequency
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Culturally relative abnormality
Unique to a particular culture
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Example of culturally relative behaviour
Witiko: culture-bound syndrome, suffered by native Canadians, who lose their appetite for ordinary food, feel depressed, and believe they are possessed by the Witiko (giant man eating monster), can lead to cannibalism and murder.
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Biases?
Gender, race, class
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Gender bias
Factors like biological+hormonal differences and the different ways men and women are bought up can lead to gender differences in freq's of disorders. Stereotypes may lead to expectation bias in diagnosis as clinicians expect to find certainDisorders
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Howell 1981
Womens experience in british culture predisposes them to depression and therefore the situation is being diagnosed not the person
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Cochrane (1995)
Explains that depression can be related to long-term effects of child abuse + also to gender-role socialisation, which produces increased female vulnerability.
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Bennett (1995)
Believes that the socialisation of men in indiustrialised societies has created masculine stereotypes that alienate men from seeking help for psychological problems.
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Racial bias
Large numbers of people of colour living in Britain are being diagnosed with mental illnesses, but the same rates of occurrence are not found in the countries of origin (therefore not genetic or biological factors)
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Cochrane (1977)
Found that immigrant groups in Britain are more likely to be diagnosed as schizophrenic than native-born people, reasons include racial stereotypes in diagnosis and greater stress, and poorer living conditions + prejudice.
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Class bias
Mental disorders in socially disadvantaged groups occurs in higher freq.
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Johnstone (1989)
Argued that social class was a factor that directly affected how someone was diagnosed with a mental illness. She showed that when people from diff classes reported same symptoms, lower classes = schizophrenic. Higher classes = depressed.
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Social drift hypothesis
The early onset of a major mental disorder might reduce the chances of establishing a career so that person 'drifts' down the socio-economic scale. Suggests class is a consequence of, rather than a contributory factor, in mental illness.
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ICD-10
WHO - codes for each illness.
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DSM-5
APA - summarises each mental issue + diagnosis using ICD-10 codes
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ICD-10 + DSM-5 similarities
Both use ICD-10 codes, both updated frequently, both found online, designed for use by professionals, theoretically easier to diagnose and treat patients
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ICD-10 + DSM-5 differences
ICD-10 = non-profit. DSM-5 = for profit. ICD-10 identifies medical issues whereas DSM-5 diagnoses and treats.
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Problems with classification systems
Diagnosis - subjective feelings. Many theories of abnormality. Little evidence of validity. Psychiatrists may not always agree category to category (not reliable). Treatment = subjective. Labelling theory. What is abnormal or normal?
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Rosenhan: Aims exp 1
Can psychiatric staff distinguish sanity and insanity?
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Rosenhan: Aims exp 2
Would staff reverse a diagnosis of insane back to sane?
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Rosenhan: research method
Field exp, participant observation and self report
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Rosenhan: IV and DV
IV: which of the 12 hospitals pseudopatient was trying to be admitted to. DV: whether patient was admitted or not.
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Rosenhan: Sample exp 1
8 confederates (3f/5m) psuedopatients, all given psuedonyms and fake occupations. The real participants were the hospital staff.
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Rosenhan: Hospitals exp 1
12 psychiatric hospitals in the US. 11 federal, 1 private. Across 5 states. Some old, some new. Some good patient-staff ratio, some understaffed.
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Rosenhan: Procedure exp 1
Pseudopatient called hospital asking for appointment. Pseudopatient complained of hearing unclear voices saying 'empty, hollow, thud'. Once admitted the symptoms ceased + they behaved normally. Spent time writing down their observations until release
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Rosenhan: Ethics exp 1
All but one pseudopatient found hospital stressful, no right for them to withdraw, no right for actual ppts to withdraw (hospital staff), deception, no protection from harm. Confidentiality and debrief were followed.
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Rosenhan: Results exp 1 hospital staff
Staff never detected pseudopatients sanity, 11 diagnosed w/Schizophrenia, 1 w/manic depression. Hospitalisation ranged from 7-52 days (avg 19 days). All given diagnosis of schizophrenia in remission, not sane.
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Rosenhan: Results exp 1 were not due to...
1) the hospitals quality 2) a lack of time to observe the pseudopatients 3) pseudopatients not behaving sanely
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Rosenhan: Results exp 1 patients
35/118 real patients voiced suspicions saying 'you're not crazy'. Real patients could detect the sanity.
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Rosenhan: Conclusions
Staff can't always distinguish sanity from insanity, Situational factors affect diagnosis, Patients are powerless and depersonalised.
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Rosenhan: Discussion exp 1
Physicians may fail to detect the pseudopatients sanity because they are strongly biased to say a healthy person is sick.
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Rosenhan: Staff can't always distinguish sanity from insanity
Any method of diagnosing that can easily make such errors cannot be very reliable.
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Rosenhan: Situational factors can affect diagnosis
Patients' behaviour was interpreted in the context of illness, the findings highlight the role of labelling in psychiatric assessment, the label continues beyond discharge.
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Rosenhan: Patients are powerless and depersonalised
Staff deprived patients of many legal rights e.g. minimal personal privacy, staff spent a low % of time with patients, strict segregation between staff and patients, staff's response to patient-initiated contact was brief/bizarre
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Rosenhan: Sample exp 2
Hospital staff
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Rosenhan: Procedure exp 2
Staff were told that the hospital would admit 1 or more pseudopatients in the next 3 months. They rated each patient on a 1-10 scale, 1=high confidence of pseudopatient. Rosenhan never sent anyone.
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Rosenhan: Results exp 2
Staff rated 83/193 new patients as pseudopatients, at least 1 member of staff alleged 41 patients with high confidence, at least one psychiatrist rated 23 patients as suspect, at least 1 psychiatrist and 1 other staff member rated 19 patients as sus.
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Rosenhan: Discussion exp 2
Findings show that the diagnosis of being insane can be altered by staff expectations. This shows that diagnosis can be reversed. Shows that the tendency to reverse diagnosis can occur when stakes are high.
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Rosenhan: Eval
Ppt observation: v detailed, high ecological val, subjective, difficult to replicate, deception. Some variables were controlled (fake symptoms etc). All results confidential.
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Affective disorder?
Depression is an affective (MOOD) disorder in which a negative emotional state affects a person's perceptions, thoughts and behaviour.
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Symptoms of depression?
Extreme sadness, loss of interest, changed activity levels, disturbed sleep, disturbed appetite, loss of energy, negative self concept, thoughts of death/suicide. (for at least 2 weeks)
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Psychotic disorder?
Schizophrenia is an psychotic illness which affects a person's ability to communicate, their thoughts, their behaviours and their perceptions. People suffering from psychotic illnesses lose touch with reality.
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Symptoms of schizophrenia?
Positive symptoms (additions) such as: hallucinations, delusions, disordered thinking and speech. Negative symptoms (taken from you) such as: affective (emotional), poverty of speech, reduced motivation.
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Anxiety disorder?
Anxiety disorders occur when anxiety becomes so extreme that it prevents the sufferer from coping with everyday situations such as OCD.
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OCD symptoms?
Recurrent, unwanted thoughts (obsessions), repetitive behaviours (compulsions). Carrying these out reduces anxiety while not carrying them out increases anxiety.
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Define abonormality 2

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Failure to function adequately

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Define abnormality 3

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Card 4

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Deviation from social norms

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Card 5

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Limitations of the deviation from social norms definition of abnormality

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