Lecture 1: Introduction to Mental Health and Illness

MBB2

Mental Health

is a state of mental well-being that enables people to cope with the stresses of life,
realize their abilities, learn well and work well, and contribute to their community

Mental illness

a clinically diagnosable disorder that
significantly interferes with an individual’s
cognitive, emotional or social abilities

Wakefield’s HDA defines mental disorders by two criteria

• Dysfunction – a failure of an internal neurobiological or
  mental mechanism to perform its natural (evolved)
  function

• Harm – this dysfunction results in harm judged by
  societal standards

This model combines biological facts with cultural values
to define mental disorder

Mental Disorder

is a syndrome characterized by clinically significant
disturbance in an individual’s cognition, emotion regulation, or behaviour that
reflects a dysfunction in the psychological, biological, or developmental processes
underlying mental functioning.

Applying the Wakefield HDA Model: Examples

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What is not a ‘Mental Disorder’?

• An expectable or culturally approved response to a common stressor or loss, such as the death of a
  loved one

Approaches to Classification Models

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Strengths and Limitations to Categorical

• Better clinical and administrative utility - clinicians
  are often required to make dichotomous decisions.

• Easier communication

Strengths and Limitations to Dimensional

• Closely model lack of sharp boundaries between
  disorders, between disorders and normality

• Have greater capacity to detect change, facilitate
  monitoring

• Can develop treatment-relevant symptom targets-
  not simply aiming at resolution of disorder (most
  treatments actually target symptoms, not disorders)

Strengths and Limitations to Hybrid

• People’s life experiences differ. This variability across individuals
  extends to states of mental health and illness as does the degree to
  which we are resilient against or vulnerable to, the latter

• It is quite complex which makes it unreliable

DSM-5-TR Diagnosis

• Diagnosis will be made on the basis of:
  • Clinical Interviews – clinician and client semi-/structured
  • Text descriptions – in DSM covering how disorders present
  • Diagnostic criteria – does presentation match checklist

• Currently presenting symptoms and severity - e.g. depressed mood

• Rule out disorder due to general medical condition – e.g. due to hypothyroidism

• Rule out disorder due to direct effects of a substance - e.g. alcohol induced

• Establish boundary with no mental disorder
  • Clinical Significance/Cultural Norms. E.g bereavement vs clinically significant depression

• Determine specific primary disorder(s)
  • Multiple diagnoses possible

• Add subtypes/specifiers
  • severity (mild moderate, severe – with or without
  psychotic features)
  • treatment relevant (poor insight, atypical, etc.)
  • longitudinal course (with/without full inter-episode
  recovery, seasonal pattern)

Semi-Structured Interview Example: Mental
State Exam (MSE)

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Structured Clinical Interview for DSM-5-TR
(SCID-5-TR)

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Case formation

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Biopsychosocial Paradigm

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Psychoanalytic Paradigm (Freud)

Freud believe the unconscious has a
profound influence on what we do
and how we feel in day-to-day life.
• Psychopathology caused by unresolved
childhood conflicts and repressed desires.
• Only through gaining awareness of
unconscious processes can individuals
resolve and recover

Behavioural Paradigm (Watson, skinner)

Goals of behavioural interventions include:

• interrupt and/or
  change
  maladaptive
  stimulus-response
  associations;

• reinforce adaptive
  behaviour.

Cognitive Paradigm (Beck)

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Hierarchical Taxonomy of Psychopathology

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Example Case: DSM vs HiTOP

The DSM-5-TR model sees this as two separate disorders that are co-occurring (or ‘co-morbid’).
• Treatment might focus on two distinct conditions.

The HiTOP model sees these as part of a shared internalizing spectrum rather than two separate disorders.
• Treatment could focus on core emotional dysregulation rather than treating two distinct conditions.

HiTOP Model: MDD and GAD Example

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Cultural Models: Australian First Nations Model of Social and
Emotional Wellbeing

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Anti-Psychiatry Perspectives

Psychiatrists including:
- Thomas Szasz: mental illness is a myth (e.g. no
disease identified)
- J.D. Laing: psychiatry inappropriately
pathologizes human distress (e.g. schizophrenia
symptoms are a normal response to adversity).
Social theorists like Michel Foucault and Erving
Goffman argued:
- psychiatry enforces societal norms.
- serves to marginalise and stigmatise those
with psychological problems.
- is coercive, pseudoscientific, and socially
constructed.
- causes harm

Cultural Models: Mad Pride

Mad Pride
A social and political movement.
Grounded in protest and challenge of stigma,
discrimination, and historical psychiatric practices
that infringe on human rights.
Pride in the self as a complex whole that incorporates
madness into identity.
Reclamation of pejorative terminology. Parallels with
LGBTIQA+ Pride movement.