hsci lecs 1-10 MIDTERM

What are 2 common ways professionals may interpret & respond to mental health symptoms?

1) Person has a disease w/ a biological cause

2) Person has a disorder --> a dysfunction that is mental in nature, whatever the cause

- may be possible that symptoms + behaviours are within spectrum of normal human responses to stressors

- ex: sadness (depression) + worry (anxiety) are experienced by everyone

T/F? - Mental health & illness are complex issues

True

What is contradictory about mental health & illness? What should you do to avoid this?

- ideas

- evidence + opinions about their causes

- definitions

- the "best" ways to preserve health & treat illness

Avoid by:

consider this topics from multiple perspectives + take a critical approach to evaluating our assumptions, definitions, and responses to mental health/illness

What is meant by mental health & illness? What subtopics should you explore to better define these terms?

- definitions of "mental health" and "mental illness" are not straightforward

- one possible definition = mental health is the freedom from suffering, abnormal behaviour, and distress

- another possibility = mental health is the absence of mental illness

* neither are very definitive --> might be useful to explore concepts of distress, abnormality & disfunction

How does distress relate to "Mental" vs. "Health" + whats the problem with this?

Mental = refers to feelings, awareness, cognition, behaviour

Health = associated w feeling good , while illness is associated with feeling bad

- distressful emotions (frustration, sadness, doubt) are normal, not necessarily illness.

Explain the significance of "Abnormality"

- another way to think of mental health + illness is to consider the contracts of normal VS abnormal

- usually assume abnormal = unhealthy --> however, many mental health disorders are very common + Normality cannot fully define mental health. For example heart disease that is unknown, is very normal in the USA, however that is unhealthy.

Explain the significance of "Dysfunction"

- if person's thoughts/feeling make it difficult for them to meet their daily needs & fulfill typical responsibilities --> this may be considered unhealthy

- BUT our individual capacity is influenced by our resources & environment

Give an example of how "dysfunction" can be influenced by an individual's resources & environment

smo may be able to afford days off work when distressed but another person may not be able to (must fulfill responsibilities)

- is first person mentally healthier than the second person? - no

How might each of the determinants influence mental health & illness?

Health Care Access & Quality -->

Education Access& Quality -->

Economic Stability -->

Social & Community Context -->

Neighbourhood & Built Environments -->

* answers prob in text book but also lowk common sense

Why is it impossible to develop a universal definition of mental health or mental illness

- Many factors influence sharing the definitions we use (they vary over time & place)

- Definitions we will examine are "ideals" rather than being fully concrete (they have strengths & limitations)

What is the WHO's definition of Mental Health? What is a positive of this definition? What is the overall message?

"A state of well-being in which the individual realizes [their] own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to [their] community"

What are advantages and disadvantages of WHO's definition for mental health?

Advantage:

- aspirational & universally agreeable definition + provides positive goals to strive towards.

- if all present, we would deem person to be mentally healthy

Disadvantage:

- Goes beyond the individual and is influenced by social determents.

- Ex. Ageism: older people seen as "less healthy," since they contribute to society less.

- Frames mental health as only an individual trait, ignoring social context. The real issue is social prejudice like sexism, racism, etc.

What does the DSM's definition of Mental illness refer to?

disturbances in cognition, emotion, or behaviour which can be attributed to mental functioning & which usually are associated w distress or disability

- touches on distress, abnormality, & disability

- also relies on the professional judgement of clinician for diagnosis

- excludes normal/culturally expected responses to loss or stress and Social deviance (political, religious, sexual) unless caused by dysfunction in the individual.

What are the strengths of DSM's definition of mental illness?

- is a flexible definition using words like "usually" and describing dysfunction as being "psychological, biological, or developmental"

- bridges variety of perspectives abt nature of mental illness --> making it possible for variety of mental health professionals to use it

- touches on distress, abnormality, & disability

What are the limitations of DSM's definition for mental illness?

- flexibility in definition may be vague or indicate lack of strong evidence abt nature of mental illness

- Relies heavily on clinician's judgment.

- Difficult to determine whether deviance = dysfunction or simply difference.

What is the disease model?

suggests that mental illness is caused as a result of biological or physiological problems.

What are problems with the disease model?

If we treat mental health and illness as absolutes (you either "have" a disorder or you are completely "healthy"), it doesn't fit reality. Mental health is a spectrum.

What is the traditional binary view?

- Sees mental health and illness as opposites — you're either "healthy" or "ill," no in-between.

What are limitations of the traditional Binary view?

-it uses Circular reasoning.

-Assumes natural state = health unless disrupted.

-Leaves power of defining illness to professionals.

- it is an oversimplified view. Mental illness is not black and white.

What are the 3 main Models of mental health and illness?

Biomedical, psychological-behavioural, and social models

- are frameworks for understanding & explaining mental problems

- practitioners rely on more than one model in their practice

- important --> theory regarding mental health & illness draws from these models

What is the Biomedical Model?

- assumes there is a binary division --> a person is either mentally ill OR mentally healthy

- sees good mental health as the natural human state

- uses a model of disease to suggest that mental illness have specific causes: biological dysfunction of the brain (even if cause not yet understood/known) + genetic

What brain-based interventions are considered the best way to treat mental illness in the Biomedical Model?

- psychopharmaceuticals

- electroconvulsive therapy (ECT)

- genetic interventions (potentially in the future)

Define "biomarkers"

a measurable substance in the body that definitively indicates the presence of a disease

are there biomarkers of mental illness?

universally agreed that there are none

- no test to prove smo is in good mental health

What is the Psychological-Behavioural Model?

- considers mental disorders to be patterns of thinking, feeling, and behaving that are harmful to the individual

- does not assume a binary btwn mental health & mental illness

- assumes symptoms exist along a continuum

- mental health & mental illness are the 'extremes' on the continuum

Explain the continuum of the Psychological-behavioural model

mental health & mental illness are the 'extremes' on the continuum:

- health = normal functioning

- mild = common & reversible distress

- moderate = significant impairment

- severe = server & persistent functional impairment

What are some of the schools of thought/practice within the Psychological-behavioural model?

- Freudian Psychoanalysis

- Psychodynamic approaches

- Behaviourism

- Humanism

All of these support the idea that mental illness arises as result of our personal experiences & perspectives

What are examples of types of psychotherapy?

- Cognitive Behavioural Therapy (CBT)

- Psychodynamic Treatment

- Humanistic therapies

- Existential approaches to therapy

What does treatment rely on for the psychological-behavioural model?

relies on psychotherapy --> talking about thoughts, feelings, and behaviours in a collaborative relationship w/ a practitioner

Define psychotherapy

talking about thoughts, feelings, and behaviours in a collaborative relationship w/ a practitioner

What is the Social Model?

- views mental health as a social product

- less emphasis on individual characteristics & qualities

- considers the individual in the context of their social environment (individual + family + community)

- good or bad mental health are socially constructed & produced (an redefined) by social relations and norms

What does the Social Model suggest? What are examples of this?

power & culture lead to labelling of some ppl --> often groups experiencing marginalization as "mentally ill"

Ex:

- homosexuality no longer considered a mental illness

- extreme shyness, in the past considered "normal human quality" but now may be referred to as social anxiety disorder

- auditory hallucinations --> hearing one's dead ancestor is celebrated in some cultures

What are examples of interventions to improve mental health in the Social Model?

social interventions:

- supported housing

- employment

- skill building

What is "Demedicalization"?

de-classifying a mental illness & looking at the social causes rather than individual causes of mental distress

- many social interventions are based on this

What is the Biosychosocial Model?

suggests that biological factors, social conditions, and individual experiences all contribute to a person's mental health

- integrates perspectives of all 3 models (biological, psychological-behavioural, social)

What are examples of social determinants of health in the biopsychosocial model?

income, housing, education, etc.

what are examples of providers/professionals of mental health care?

- psychologists

- psychiatrists

- social workers

- registered psychiatric nurses

- counsellors, therapists, psychotherapists

- life coaches

- religious advisors

- peers/fellow patients/clients with lived experience of mental illness

Why is measuring/assessing a person's mental health not straightforward but rather complex?

mental health cannot be objectively measured --> requires subjective assessment (by clinician)

How do mental health providers determine if smo is experiencing mental illness?

Diagnostic tools:

- Diagnostic and Statistical Manual of Mental Disorders (DSM)

- International Classification of Diseases (ICD)

^^^guide professionals (psychologists/psychiatrists) as they categorize & diagnose mental illness

- also used by researchers, governments, and health insurance companies

What is the DSM? How does it work?

- produced by the American Psychiatric Association

- currently in 5th edition

- 1st edition published in 1952

- descriptions of each diagnosis (or disorder) & includes a checklist of their symptoms (thoughts/moods/behaviours) used to determine if a specific diagnosis applies

- practitioner observes & speaks w patients/clients to gather info to make diagnosis

How does the DSM evolve with each new edition?

- revisions made

- some disorders removed or redefined

- new disorders added

- symptoms list for disorders are modified/updated

What is the International Classification of Diseases (ICD)? What makes it different from the DSM?

- produced by the WHO

- currently in 11th edition

- started in 19th century

- includes all recognized health conditions (not just mental disorders)

- also includes diagnostic criteria

- definitive classification schemes = highly relevant to public health --> we use them to track mortality, morbidity, & treatment in health admin. data

What are clinical scales?

- another important diagnostic tool

- measure patients mental state w/ series of "standard" questions

- answers can be used to determine severity of condition

- Ex: Hamilton Depression Rating scale

What is the Hamilton Depression Rating Scale?

- scale = widely available in 2 common versions (either 17 or 21 items, scored btwn 0-4 points)

a "score" for a series of questions/item

- indicates whether person qualifies for diagnosis & how severe their condition may be

- 17 items measure severity of depressive symptoms

- interviewer rates: level of agitation clinically noted during interview + how mood is impacting on individuals work or leisure pursuits

Explain the Hamilton Rating Scale for Depression

Scoring is based on 17-item scale & scores of:

- 0-7 = normal

- 8-16 = mild depression

- 17-23 = moderate depression

- over 24 = severe depression

- max score being 52 on the 17-point scale

What are examples of potential for bias in diagnosis?

- classification systems are human made & subject to biases

- clinicians may display biases related to patient characteristics (race/class/gender/weight)

- clinician characteristics may be influential too: training, race, gender may influence diagnoses

Why might diagnostic criteria be biased?

- symptoms list/criteria make some individuals more likely to be diagnosed w particular conditions --> ex: males are more likely to be deemed to have oppositional defiant disorder & conduct disorder

- unrecognized class/race/gender bias among those creating diagnostic criteria

- specific symptom checklist for mental disorder ma make it more likely that some groups receive diagnosis

- committees lack diversity --> upper middle class --> might lead to diagnostic criteria that function to reinforce cultural norms

- unrecognized or un-reported conflicts of interest may exist

T/F? - There are many debates and complexities related to diagnostic systems and the DSM

True

Why does mental health matter?

- it influences how we experience the world --> good mental health = easier to cope/navigate challenges --> poor mental health = more difficult + more distress/discomfort

- it helps us understand & explain our actions and behaviours

- has social meaning --> can be part of our identities (living as smo w depression or anxiety)

- diagnosis is often the gateway to treatment and/or getting better

- diagnosis may also result in stigmatization/mistreatment

- diagnosis can result in involuntary treatment (for ppl under a Mental Health Act)

- behaviours deemed problematic = increasingly explained in terms of mental disorders

What does it mean that behaviours deemed problematic = increasingly explained in terms of mental disorders?

traits like shyness, narcissism, hyperactivity and anxiousness have become medicalized + are now symptoms for mental disorders

What is the goal of public health in relation to mental health?

to decrease suffering

T/F - The debate abt whether mental illness is a romantic (physical/biological) or psychological problem has been going on for centuries

true

What characterized the history of ideas about mental health & illness?

significant shifts in thinking

Why might understanding the history of ideas abt mental health & illness be beneficial?

helps us take a critical approach to current assumptions abt mental health & illness

- knowledge is continuously evolving

What is Whig History? What are the cons of it?

- misrepresentative of actual history --> oversimplification

- selectively focuses on a few notable individuals

- assumes human progress is assumed to be inevitable & positive --> evolving but always improving

Cons:

- improvements happen BUT life does not necessarily get better (WWII)

- women & other marginalized groups often underrepresented

What is the Social History approach?

- key achievements/notable individuals & daily lives of ordinary ppl --> how they may have experienced cultural or scientific change

What makes it difficult to acquire full understanding of the history of mental health & illness?

there are many gaps in the historical record

- "like mental health, the past is complex, and our understandings are imperfect, open to debate, and ever-changing"

Define "Madness"

"Madness" = an elastic concept that helped explain a range of unusual, bizarre, or irrational human behaviours

how does madness relate to mental health before the 18th Century

the belief that strange cognitive & behavioural symptoms might be caused by disease only became more prevalent in the 18th century

Define the 3 ways of madness before the 18th century

explained in various ways in relation to diverse causes, naturally and supernaturally:

- punishment or misfortune (demonic possession; spirits)

- psychological (mishaps in love, driving smo "mad")

- physical (head injuries, balance of body "humours")

How was madness treated before the 18th century?

- trepanning (puncturing skull w holes)

- religious ceremonies

- beatings

- counter spells

What is trepanning?

puncturing skull w holes

What happened to madness in the 19th century?

- hospitals for those deemed "mad" were first developed in early islamic societies, later appeared in Europe

- early example of madness being tied to medicine

Why is madness as understood in the past not the same as our modern ideas abt mental illness?

- may include/exclude behaviours now associated w mental illness

- norms of behaviour change

- second & third-hand accounts may not be accurate

when was madness transitioned into being known as "mental illness"?

late 18th century

Define Medicalization --> How does it relate to mental illness?

the process where a condition becomes understood as something that should be treated by physicians

- mental illness became medicalized thru a long process

- non-medical treatments continued to be used & to evolve

What factors contribute to the medicalization of mental illness?

- challenges to the authority & power of the church in Europe

- The Scientific Revolution --> idea that science could solve problems & explain the natural world

- The Enlightenment --> skeptism abt religion, focus on rationality

- shift to viewing madness as a medical problem

- ppl increasingly viewed as victims & not to be blamed

- medicalization challenged religious explanations for madness

- Increased urbanization

How did increased urbanization contribute to the medicalization of mental illness?

increased visibility of ppl who appeared as "mad" perceived as "dangerous"

- public attention increased & states increasingly incarcerated

- institutional care increased --> charitable home / for-profit "madhouses"

Explain the rise of physicians

- scientists & physicians became more respected in society

- formed professional organizations

- viewed as protecting against wrongful confinement

- made responsible for inspecting & licensing/regulating asylums

- public attention to poor conditions of "madhouses" increased

Explain the rise of the asylums

19th century --> large state-run institutions or mental hospitals:

- care of ppl w mental illness

- business & an industry

overseen by physicians who specialized in mental illness

Asylums = key component of the mental illness care system thru 1960s

Some asylums still exist today

Name the 2 different major arguments posed by historians to understand the rise of the asylum era

1) Moral treatment

2) Social control

What is the Moral treatment?

- the foundation of the asylum mvmnt in the treatment of mental illness

- a philosophy that emphasizes human treatment rather than restraint & punishment

- attempt to restore mental health

- calm environment --> new skills, work, recreational activities

What was the goal of the Moral treatment?

end dehumanizing treatment --> provide active treatment

What were the cons about the Moral treatment?

- few asylums lived up to this standard

- noble but failed experiment to better manage mental illness

- overcrowding, insufficient funding + understanding

What is Social control (in terms of mental asylums)

- Asylums were used to remove "problematic" individuals from society.

- People violating social norms were labeled mentally ill and confined.

- These individuals were sent to asylums, workhouses, or prisons.

- Psychiatrists seen as agents of control, not care.

- Mental illness framed as abnormal or antisocial behavior.

- Asylums weren't a solution, but a precursor to broader confinement.

- Once built, they were filled—more behaviors were redefined as mental illness.

- By late 19th century, critiques saw asylums as places of confinement, not cure.

- Argument: This wasn't a failed system, but one fulfilling its true purpose.

- The hidden agenda of social control was succeeding.

Define Organic lesions vs. hereditary causes of mental illness

Organic lesions = acquired during one's life

- identified via autopsies & surgical techniques --> a biological/organic view of mental illness

- treatment involved a range of interventions for temporary relief --> including bleeding and purging

Hereditary (genetic)

- eugenics mvmnt to "reduce prevalence of mental illness"

- by forced sterilization and lifelong institutionalization

who is Sigmund Freud? What were his techniques + perspectives?

- trained neurologist

- mental illness was psychological in nature emphasizing importance of personal experiences & unconscious mind

- his treatment techniques focused on helping patients access/understand their unconscious thoughts + urges

- used dream analysis, free association, hypnosis (psychoanalysis)

How is Freud's perspective still influential?

- extended definition of mental distress --> included more "mild" forms of anxiety + depression

- moved treatment from hospitals to private offices --> "the psychiatrists couch"

- childhood experiences influence our mental health in adulthood --> esp in interpersonal relationships

- modern treatment for mental illness --> ex: talk therapies or psychotherapy

how did psychoanalysis inform the understanding & treatment of trauma?

- during WWI soldiers were presenting w symptoms related to combat trauma --> described as "shell shock" and "war neurosis"

Who is the WHR Rivers?

a medical doctor & anthropologist at Craiglockhart Hospital in Scotland

- treated Manu wounded & former WWI soldiers

- syndrome & symptoms = memory disturbances, temporary blindness, paralysis w/o evident physical cause (viewed as unconscious defence mechanism)

- recessed emotions/memories during combat moved to conscious as survival instinct

What were the treatments for traumatized soldiers?

- partially based on Freud's ideas: psychotherapies --> process unconscious memories

- modern conceptualization of PTSD in DSM is related to these early ideas but not the same

How has psychoanalysis formed the Attachment Theory? What is the attachment theory?

1940s focused on child development, the mother-child relationship & how these may impact adult mental health

- "Good mothering" --> foundation for emotional health & healthy relationships

- attachment theory remains an important aspect of child psychology research & practice

Psychopharmaceuticals

Medications that are psychoactive, they impact mood, thoughts, or behaviour; they are prescribed for psychiatric reasons.

Role of Medication in Depression

Questions include whether medication alleviates/cures depression, aids counselling, or is a placebo effect.

Growth of Psychopharmaceuticals

The use of psychopharmaceuticals has grown a lot the mid-and is highly prominent in the modern treatment of mental illness.

Common Treatments

Medications are commonly used to treat mental illness, alongside therapies (e.g., CBT) and lifestyle modifications (e.g., nutrition, exercise, sleep).

Limitation of Medication as Treatment

Hard to know how much positive change comes directly from the medication versus other parts of treatment.

Unclear Role of Medication

The role of medication in recovery processes may be unclear, with differing views on its effectiveness.

- One view is that drugs cured depression and addressed a chemical imbalance.

- Another view is that drugs aided the recovery process, allowing progress and breakthroughs to be made in therapy.

- The potential for a placebo effect, especially when combined with counselling and exercise, is acknowledged.

Pre-History of Psychopharmaceuticals

- Psychoactive Drugs: Substances that affect feelings, thoughts, and behaviors.

- Historical Use of Psychoactive Drugs: Humans have used substances like alcohol, caffeine, and cannabis throughout history.

- Modern Psychopharmaceuticals: The rise of a global consumer culture and the psychopharmaceutical industry reshaped how we think about these drugs.

Influence of Psychopharmaceuticals on Psychiatry

The rise of psychopharmaceuticals has shaped how psychiatrists think about mental illness, encouraging some to see it as neurobiologically based.

Limitation of Psychopharmaceuticals

Historical evidence suggests medications are not "magic bullets" that cure mental illness.

Magic bullets

A term used to describe medications that are believed to cure diseases effectively and directly.

Effective Use of Psychopharmaceuticals

Requires intelligent skepticism, careful clinical judgment, and awareness of cultural and commercial influences.

Role of Historical Awareness

Understanding the history of psychopharmaceuticals helps guide ethical and effective treatment.

US and the Psychopharmaceutical Industry

The US played a key role in developing the industry and has historically been a major market.

Historical Use of Psychoactive Drugs in the US

Alcohol, morphine, and cocaine were widely used at different times, with varying levels of regulation.

Patent Medicine Market

Morphine and cocaine were often sold in unregulated "patent medicines," advertised directly to consumers without full disclosure of ingredients.

Alcohol Use in US History + Alcohol Prohibition

- Alcohol was prescribed as medicine and used therapeutically and recreationally.

- Later concerns about alcohol harms (to families and communities) led to its prohibition, highlighting social and moral dimensions, not just medical issues.

Cocaine

A drug sold and marketed as a brain tonic and stimulant.

Intelligent skepticism

The practice of questioning and critically evaluating the information and practices related to psychopharmaceuticals.