Transcript History of mental healthx

Issues in mental health
The historical context of
mental health
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Issues in mental health
Use results to compare, analyse data, calculate
Integrating by age, 2012
% agreeing
82
71
57
76
86
81 80
70
60
16-34
36 37
35-54
55+
What percentage of people over 55 agreed with the view
that people with mental illness are far less of a danger than
most people suppose
28
People with mental illness Mental illness is an illness No-one has the right to
are far less of a danger
like any other
exclude people with
than most people suppose
mental illness from their
neighbourhood
Mental hospitals are an
outdated means of
treating people with
mental illness
Base: 16-34 (580), 35-54 (529), 55+ (618)
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How many men and how many women agree with the view people with mental health problems should
have the same rights to a job as anyone else ?
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Just over seven out of ten (___%) agreed that ‘Most people with mental
health problems want to have paid employment’, and around ?
?
that ‘If
a friend had a mental health problem, I know what advice to give them to
get professional help’ (68%) and that ‘People with severe mental health
problems can fully recover’ (64%).
’.
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How many people were very unlikely to consult a GP in 2011?
How many people were very unlikely to consult a GP in 2014?
Does this tell us anything?
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What do we think about mental health?
Answer the questions on the google form
Compare our results to the nation’s results
Each group will take one point and summarise
Why the differences in age and gender
How does 2012 and 2014 questions compare
Evaluate
this reaserach
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How have wards change over time?
https://www.youtube.com/watch?v=g6fdMOWjL2E
https://www.youtube.com/watch?v=D8OxdGV_7lo 5.49
Read Rosenhan
Compare with
http://slam.nhs.uk/our-services/hospital-care/bethlem-royal-hospital/explore-bethlem
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What is wrong with Hilda Smart?
Read case notes
Listen and read along (pages 5 -7) to help you fill in the following table
Prehistoric
Early Chinese
Ancient
Greece
Middle ages
Today
Extension: Do the same again for another patient
What evaluations issues and debates link with these explanations?
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Historical views of mental illness
 Demonic possession and witchcraft.
 Madhouses and bedlam; mentally ill seen as wild animals.
 Late eighteenth century – emergence of psychogenesis –
Mesmer. Link between psychology and biology as causes.
 Early 1900s – Psychoanalytical theories and Biological
theories develop.
 Behavioural theories develop in the early twentieth century.
 Humanistic & Cognitive theories 1950s onwards.
 1950s – asylums renamed mental hospitals. Rise in drug
therapy.
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Trepanning
This is the process of drilling holes into the skull to release demons.
Skulls dating back to 6500BC have shown evidence of this.
Some of the skulls show that the holes have healed suggesting that
some people survived the ‘treatment’.
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Madness
The idea of madness has been around for a very long time.
The term ‘madness’ features in the Old Testament and this was
perceived as a punishment from God.
Some treatments have used exorcisms to rid the patient of evil spirits.
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Hippocrates
Hippocrates was the first to suggest
that mental illness was a scientific
phenomenon.
He suggested that madness was
caused by an imbalance of the four
bodily humours and could be treated
by balancing these four humours.
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Impact of the Church
The Greeks continued to investigate mental health as an imbalance but
with the growth of the Christian Church in AD300, the idea of madness
as a punishment from God became the dominant theory.
Religion was also the primary care system; such as the Bethlem
Hospital in London.
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The Middle Ages
In the fourteenth and fifteenth centuries the burning of witches reached
its peak.
As time went on some believed that these burnings were not related to
witchcraft but forms of mental illness, such as hysteria and epilepsy.
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Moral treatment
As we move through history, the treatments become more patient
focused.
The role of emotions and exposure to stressors became more
important.
This treatment involved:
• respect for the patient
• a trusting relationship between patient and doctor
• a calm environment
• a routine.
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Nineteenth century
This century saw the rise in the number of mental hospitals in North
America and Britain.
Psychiatry became a recognised medical specialty.
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Modern psychology
Beginning in the 1890s, modern psychology has seen many different
approaches to mental health.
Freud’s theories of the unconscious, the humanistic beliefs of self-worth
and the behaviourists’ ideas of learned behaviour are just three of the
many differing views of the last and this century.
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How have times changed?
Read pages 33-34
Draw a timeline
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Is Hilda Smart normal? What is normal?
Identify four definitions of abnormality (must be related to mental health)
According to each one would Hilda be considered abnormal?
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Statistical infrequency
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Acting against social norms
Social norms are expected approved ways of behaving.
If a man were to dress like it was winter when it was 30 degrees
outside, he would be seen as abnormal.
If abnormality is seen as any behaviour which deviates from social
norms, can we conclude that this behaviour indicates the presence of a
psychological disorder?
Why might you have to be careful with this definition, especially when
thinking about different cultures?
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Failure to function adequately
Under this definition, a person is considered abnormal if they are
unable to cope with the demands of everyday life.
They may be unable to perform the behaviours necessary for day-today living, e.g. self-care, hold down a job, interact meaningfully with
others, make themselves understood, etc.
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Deviation from ideal mental health
Under this definition, rather than defining what is abnormal, we define
what is normal/ideal and anything that deviates from this is regarded as
abnormal.
To have an ideal mental health the patient should:
• have a positive attitude of themselves and be capable of some
personal growth
• be independent and self-rewarding
• have an accurate view of reality
• have positive social interactions with friends and family.
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Rosenhan and Seligman (1989)
This idea was later extended by Rosenhan and Seligman (1989) to include the
following explanations for abnormality:
• Suffering – a person has negative consequences of their behaviour.
• Maladaptiveness – not fitting in with society and maintaining normal social
contracts.
• Unconventional behaviour – something that wouldn’t be expected by society.
• Irrationality in behaviours that others wouldn’t be able to understand.
• Unpredictability or loss of control that may be unpredictable to the observer
or the person exhibiting the behaviour and is not what we would expect.
• Observer discomfort due to the unpredictability and irrationality of the
behaviour.
• Violation of moral standards where behaviour fails to meet the standards set
by society.
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Johoda (1958)
Johoda also defined what ideal mental health was:
•
•
•
•
•
•
Have a positive attitude of themselves.
Be capable of some personal growth.
Be independent and self-rewarding.
Have an accurate view of reality.
Be resistant to stress.
Be able to adapt to their environment.
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Categorising mental disorders
The two main approaches that you need to know about are the
Diagnostic and Statistical Manual of Mental Disorders (DSM) and the
International Classification of Disorders (ICD).
DSM is predominantly used in the USA and the ICD is used by the rest
of the world. The most recent versions of the two books have seen
them become closer in their ideas.
Both are regularly updated in order to change with society, e.g. the
removal of homosexuality as a mental disorder from DSM in 1986.
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Krimsky and Cosgrove (2012)
They found that 69% of the panel working on the new DSM-5 had links
with the pharmaceutical industry.
Sroufe (2012)
Suggested that ADHD cannot be treated by drugs (the most common
treatment) and the use of drugs just allows those in authority to ignore
the larger issue.
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DSM-5
Ready for use in 2013, this version added some more contemporary
disorders, e.g. hoarding.
It also saw the removal of specific types of schizophrenia as these
tended to lack reliability and had poor validity.
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ICD-10 (ICD-11 due 2017)
This came into use in 1994 and is used by all member states of the
World Health Organization.
Chapter V (F) refers to mental disorders and has 100 categories of
disorders.
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Gender bias – Ford and Widiger (1989)
The validity of these diagnostic tools was tested by Ford and Widiger.
They found that presenting the same symptoms to clinical
psychologists (but changing the gender) led to a different diagnosis.
Females were more likely to be diagnosed with histrionic personality
disorder and males with antisocial personality disorder.
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Kappa values – Spitzer and Fleiss (1974)
The reliability has also been tested by Spitzer and Fleiss.
They found an agreement of 0.52 (scored 0 to 1, with 0 being no
agreement and 1 being perfect agreement).
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in mental health
Key
research:
Rosenhan (1973)
https://www.youtube.com/watch?v=
D8OxdGV_7lo
https://www.youtube.com/watch?v=3
MRPICpCNrU
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Rosenhan’s aims
1. To test the diagnostic system used by hospital staff to identify
mental illness.
2. To document the experiences of psychiatric hospitalisation.
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Sample
The sample were those who were being observed, i.e. doctors,
nurses and patients at the two institutions (across five different states
on the East and West coast of the USA).
So, NOT the pseudo-patients!
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Experiment 1
•
8 pseudo-patients
3 women and 5 men – gave fake names
•
Rang up 12 different hospitals stating that they were hearing voices in
their head.
‘empty’, ‘hollow’ and ‘thud’ in an unclear, unfamiliar voice of
someone the same gender as them
•
All of the pseudo-patients were admitted. All but one were diagnosed as
schizophrenic, the other diagnosed as manic depressive.
•
Once they were in the hospital they stopped simulating symptoms and
responded normally to instructions.
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Experiment 1 Results
• Once inside the hospitals their normal behaviours were perceived as
being reflective of their illness.
E.g. note taking seen as obsessive writing behaviour, and
queuing was seen as oral acquisitive syndrome.
• On average, the pseudo-patients were in the mental homes for
19 days before being able to leave.
min 7 days – max 52 days.
• The real patients recognised them as frauds.
• The pseudo-patients were now participant observers.
Recording everything they saw and experienced.
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Experiment 1 Results
• Treatment of those who are mentally ill is different to treatment of
those with a physical ailment or disability and is viewed negatively,
even by professionals.
When pseudo-patients asked ‘When am I likely to be
discharged?’ the professionals would often ignore them and
treat them in an offhand manner.
• Patients felt powerless and depersonalised.
• Their labels had ‘stuck’.
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Recordings (responses of staff to pseudo-patients)
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Comparison studies
These findings were compared to responses to a young female student
approaching a faculty member at university asking questions such as:
‘Pardon me, could you direct me to Encina Hall?’
‘Do you teach here?’
Everybody answered the questions and no one ignored her – this was
in stark contrast to how the pseudo-patients were treated.
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Experiment 2
• Many mental institutions criticised Rosenhan’s experiment and said
it wouldn’t happen at their hospital.
• Rosenhan informed a large hospital that at least one new patient
would be trying to gain admittance over the next three months as a
test of how rigorous their diagnosis procedures were.
• However, in this time no pseudo-patients tried to gain admittance.
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Experiment 2 Results
• 41/193 patients were judged by at least one member of staff as
being fake.
• 23 were rated highly confident by at least one psychiatrist and 19 by
a psychiatrist and by at least one other member of staff.
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Conclusion
Rosenhan suggests we cannot distinguish the sane from the insane in
psychiatric hospitals.
DSM-2 was not valid (not accurate in diagnosis) or reliable (not
consistent in spotting sane or insane but was consistent in diagnoses –
11/12 diagnosed as schizophrenic). This led to many changes for later
versions.
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Do you consider this study
to be time locked?
Can we be confident that the results
are accurate?
Are any ethical guidelines broken?
Evaluation
How useful is this study?
Does the fact that the sample were friends of
Rosenhan, and Rosenhan himself, matter?
Who can you generalise the results to?
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Application
For this you need to know characteristics for an affective disorder, a
psychotic disorder and an anxiety disorder.
• Affective Disorder – mood disorders such as depression
• Psychotic Disorders – where a patient has lost touch with reality,
such as schizophrenia
• Anxiety Disorders – including phobias and PTSD
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Domino activity
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Application task
Using your textbook, the Activity 1 sheet and the internet, investigate
the symptoms of depression, schizophrenia and agoraphobia.
Remember to look at both the DSM-5 and the ICD-10.
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