Issues in 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. 

Defining abnormality

 Statistical infrequency 

Deviation from social norms 

Deviation from ideal mental health 

Maladaptiveness 

Categorising mental health disorders

DSM-V. Particularly used in USA

ICD-10. Predominantly used in rest of the world

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. 

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.

Rosenhan's aims 

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 

Field study

Participant observation 

Self report

Field experiment due to:

Independent variable- the 12 different hospitals 

Dependent variable- the treatment and experience of the pseudopatients 

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 

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. 

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 

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 

Part (d)-

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 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

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 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. 

Research method 

National register-based cohort stufy in Denmark

Secondary data 

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.

Schizophrenia- 

Both parents- 27.3%

1 parent- 7%

Neither parent- 0.86%

Bipolar-

Both parents- 24.9%

1 parent- 4.4%

Neither parent- 0.48%

Uncleaned population- 

14.1%

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. 

Application-  

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

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.