psychology mental health OCR a level

Prehistory Aetiology

supernatural. abnormal behaviour attributed to witchcraft, religion and demonic possession. people also believed that mental illness was a punishment for wrongdoing

Prehistory treatment

prayers and immersing in holy water. exorcisms and trepanning,stretching and whipping.

Greek aetiology (400BC)

Hippocrates argued for 4 humors. Black, yellow, blood and phlegm. Each relate to personality:

Black- quiet, introverted, serious

Yellow- impulsive, ambitious, relentless

Blood- courageous, hopeful, playful

Phlegm- calm, patient, peaceful

Health=balanced. Disorders= imbalances

Greek treatment (400BC)

Purge patient to regain balance. Laxatives and bloodletting. changes in lifestyle- exercise and diet. Physiological remedies understanding too.

Psychogenic aetiology (1900s)

attributed mental illness to psychological factors. Freud- unconscious process in brain. Thoughts we are unaware of

psychogenic treatment (1900s)

psycho-analysis. insight into past and thoughts of unconscious. Dream analysis- lead to talking therapy.

somatogenic aetiology (mid-late 1900s)

biological dysfunction- study brain. abnormal brain structure and abnormal levels of neurotransmitters and inherited genes.

somatogenic treatment (mid-late 1900s)

assumtion that physical treatment would be solution. electroconvulsive therapy and psycho surgery. drug treatments now common- control symptoms

Statistical infrequency

A behaviour that is statistically infrequent and does not happen very often. Less people attain score further from average- normal distribution. Example- Necrophilia- uncommon.

S- objective

W- need accurate data and no differentiation between what is statistically infrequent and what is undesirable.

strengths of statistical infrequency as a definition of abnormality

the mathematical nature of this definition makes this more objective and provides clear guidelines as to what is abnormal/ normal.Provides a useful overview as it looks at the full picture, taking all the population into account, this could provide useful insight into the whole picture of a particular characteristic

Weaknesses of statistical infrequency as a definition of abnormality

Abnormal behaviours can occur frequently, for example mood disorders like depression occur frequently.25% of the population will experience a mental health issue at some point in their livesThe mathematical nature of this definition means it does not consider cultural variances as abnormality could be widespread in one culture in comparison to others

Deviation from social norms

Abnormal behaviour is seen as a deviation from unstated rules about how one 'ought' to behave. Anything that violates these rules is considered abnormal. Example- Drapetomania- slaves irrational desire to run away.

S- classification good in context, allow identification of behaviours that may be damaging to society

W- subjective, social norms change- depends on culture, context and age

Deviation of ideal mental health as an explanation of abnormality

It is considered abnormal if you do not have a:

Positive view of yourself

Incapable of personal growth

Not self regulating etc

strengths of deviation of ideal mental health as an explanation of abnormality

It takes into account whether behaviours are affecting our mental well being

weaknesses of deviation of ideal mental health as an explanation of abnormality

Most people will go through periods of time when they do not have ideal mental health i.e. bereavement.

Definition is based on an individualist culture view of ideal mental health. Some cultures are collectivist.

failure to function adequately as a definition of abnormality

If a person can not function independently in society it is considered dysfunctional

strengths of failure to function adequately as a definition of abnormality

Maybe an indication that a person may be struggling and need support

weaknesses of failure to function adequately as a definition of abnormality

Most people will go through periods of time when they may need support i.e. bereavement.

categorising disorders

done by using classification systems, which aim to provide a diagnosis

used to identify a disorder and allow the clinician to find a treatment

ICD-10 - International classification of diseases

diagnostic tool for physical and mental disorders- involved cross cultural collaboration

set up to help track and diagnose diseases and mental health issues world wide - now published by WHO

- has descriptions of the main features of mental health disorders and each section indicates how many features of a disease might be required in order to diagnose the problem

The technicalities of the DSM

contains only mental illnesses, as opposed to ICD-10

Removed homosexuality in DSM III

The newest system has removed the multi-axial system it used to have - which used to ensure the holism of the diagnosis, taking into consideration factors like global functioning

DSM V includes 20 categories of disorders i.e depressive disorders

listed in lifespan order

disorders now come with a spectrum of severity

it provides assessment tools for disorders

provides an alternative way of classifying personality disorders

the technicalities of the ICD

* has 21 chapters, each chapter has several categories

Mental and behavioural disorders - Chapter V

this chapter has 11 sub categories such as mood affective disorders like bipolar disorder

DSM- Diagnostic and Statistical manual of mental disorders

Set up in the USA by a team of mental health professionals from across the world to improve the reliability of mental health diagnosis

DSM is more complex than the ICD - the DSM V includes a range of 'Axis' (VARIABLES) to be considered alongside the features of the mental health conditions such as environmental problems

S/W of DSM

S- reliability- classification systems try to improve reliability of diagnosis by having standardised guidelines.

Validity- measures what it claims to measure

W- Reliability- still problems- self report and not consistently followed

validity- biases and cultural differences

ICD vs DSM

both use categories and are useful- help diagnosis

different- ICD intended as classification, DSM is fully comprehensive diagnostic manual

Rosenhan Aim (study 1)

Test the validity/reliability of diagnostic system. Aim to see if sane people acting as having a disorder could be diagnosed as insane by staff at psychiatric hospitals

similarities of the ICD 10 and the DSM 5

Both diagnostic tools for mental disorders

Both are reviewed regularly so that they are up to date

differences between the ICD 10 and the DSM V

ICD made by WHO - DSM V made in the US- but used worlwide

ICD 10 is much more simplistic tool only lists syptoms of mental health descriptions - DSM V uses Axis- taking into consideration other factors i.e loss in the family - therefore more complex tool

ICD 1O- reductionist- DSM 5 more holistic- less holistic then it used to be as removed some of its axis like the fifth axis- where patient was given a score out of 10 on ability to function- however still more holistic

Rosenhan background

1960s psychiatrists and psychotherapist started criticising the medical model of abnormality

Rosenhan was part of this movement

prosecution v defence psychiatrists

wanted to test the validity and reliability of psychiatric diagnosis

Rosenhan method (study 1)

Covert participant observation where pseudopatients pretended to be real patients and recorded activity at the hospital

Rosenhan participants (study 1)

Staff/patients at 12 hospitals from 5 states in USA 1960s. private, public, new, old. (8 pseudopnmatients were confederates) 3 women 5 men

Rosenhan procedure (study 1)

Reported hearing voices (common symptom of schizophrenia)

One admitted-stopped showing symptoms and behaved normally

Made notes of everything that happened

remained for 7-52 days

no pseudo-patient was suspected by staff

but 35/118 patients suspected - 'you're not crazy'

All discharged with Sz in remission

Rosenhan DVs (study 1)

Responses to patients

Minutes staff spent with patients

Number of times psychiatrists left cage

Eye contact

How they were treated

Rosenhan quantitative results (study 1)

(psych) Responses to requests by patients-7%

(nurses) Responses to requests by patients-3.6%

Minutes staff spent with patients- less than 7 mins

Number of times psychiatrists left cage- 6-7 a day

Eye contact avoided- 71%

Length of hospitalisation- 7-52 days (19 average)

Rosenhan qualitative results (study 1)

Normal behaviour like queueing early for lunch was seen as patological behaviour - effect of labelling

Powerlessness- lack of personal privacy-toilets did not have doors and hygiene was monitored

Depersonalisation led to an overwhelming feeling of powerlessness in the patients- ignored when tried to talk or verbal abuse

Rosenhan conclusion (study 1)

Diagnostic invalid

likely to diagnose healthy as sick- Type 1 error

Rosenhan aim and background (study 2)

Hospitals believed they wouldn't make the same error. Opportunity to see if the insane wouldn't be diagnosed as sane, and see if they would be under cautious

result from mini experiment

only 4% of pseudo patients received a response from the 185 occasions

vs

all 14 x at the university had received a response

Rosenhan method and participants (study 2)

Self report in natural environment.

Hospital staff

questionnaire

Rosenhan procedure (study 2)

Told hospital that some patients in 3 months would be pseudopatients. SENT NO PATIENTS

all staff were asked to rate all patients who sought admission using a 10 point rating scale where 1 reflected high confidence that the patient was a pseudo patient

Rosenhan results (study 2)

Patients admitted 193

Patients alleged to be pseudopatients (staff) 41

Patients alleged to be pseudopatients (doctor) 23

Patients alleged to be pseudopatients (2 staff) 19

Rosenhan conclusion (study 2)

Unreliability of diagnostic. More likelyy to diagnose sick as healthy- TYPE 2 error

Rosenhan overall conclusion

Diagnostic system invalid and can't distinguish from insane. Stickiness of labels- once labelled hard to overcome- situational

Rosenhan strengths

Sz- high reliability- all diagnosed in remission

Observation reliability and inter-rater reliability was high- similar experiences

Ecological validity- real hospital unaware- true behaviours

Changed view in how to diagnose- DSM update

Quant and Qual data

Rosenhan weaknesses

Ex2- different diagnosis- unreliability

No direct comparison of observations

Not current- low temporal validity- 1973

Ethnocentric- only USA- not generalisable

DSM- based on social norms of west

Covert- ethical issues and not always accurate

Rosenhan useful

Progressed understanding beyond previous

Provoked further research

Development for treatments- practical apps

free will/ determinism in viewpoints of mental health

historical viewpoints- deterministic

hippocrates- biological determinism

failure to function adequately definition of mental health - free will as a person is free to adjust or control aspects of their life i.e through help- these are not preditermined and can change

Rosenhan validity

real hospitals with real staff who were unaware of the observation hence this enhances external validity

Despite natural setting - pseudopatients followed a standardised procedure inside and during admission - which allowed for direct comparison between hospitals- enhances internal validity

Rosenhan reliability

Brown et al found a correlation of +67vfor repeat diagnosis of depression using the DSM IV

Rosenhan sampling bias

used a variety of hospitals across America to try and make it generalisable

however, cannot be generalised outside of America

conducted in 1970s and methods of diagnosis have changed since then

Rosenhan Ethnocentrism

DSM - based on social norms of dominant culture

ethical considerations- Rosenhan

unethical for pseudo patients to spend time in a psychiatry ward- but part of the research team

psychiatrists were deceived - none of the medical staff were able to provide their informed consent

no physical harm, but there may be psychological harm made - anger and embarrassment from widely documented publication of the research

Rosenhan - socially sensitive research

stickiness of labels

psychology as a science- abnormality

older historical viewpoints of mental illness don't support the view of psychology as a science

statistical infrequency- most scientific- measurable concepts

AFFECTIVE DISORDER

'mood disorders' have a significant effect on an individuals emotional state

includes major depression

PSYCHOTIC DISORDER

a psychological disorder in which a person loses contact with reality, experiencing irrational ideas and distorted perceptions

schizophrenia

positive symptoms

- hallucinations

and/or delusions

negative symptoms

- alogia- speech poverty

disorganised thought or speech (cognitive deficits)

Major depression (AFFECTIVE DISORDER)

Affects all age groups

2x more to women- women talk more about their feelings

depression exogenous in response to a life event

low mood most of the day

lost of interest and pleasure

reduced energy levels

changing sleeping patterns

specific phobias DSM

Fear about object/situation

Provokes immediate fear

Actively avoided with intense fear

Fear out of proportion

Persistent- 6 months or more

Significant distress/impairment in social areas

Not better explained by other disorder

Animal, blood-injury, natural environment

ANXIETY DISORDER

characterised by feelings of anxiety and fear- have physical reactions such as an increased heart rate

specific phobias- characterised by a strong, persistent and irrational fear of anything

individual might go through extreme measures to avoid said fear

symptoms

marked fear or avoidance of said object

symptoms of anxiety- sweating, trembling, heart pounding

significant emotional distress

THE MEDICAL MODEL SOMATOGENIC APPROACH - BIOCHEMICAL EXPLANATION OF MENTAL ILLNESS

focuses on abnormal levels of neurotransmitters- neurones transfer messages and information is transmitted chemically at the synapse

BIOCHEMICAL EXPLANATION OF MAJOR DEPRESSION

monamine hypothesis- depression caused by low levels of monamines (neurotransmitters) these include noradrenaline, seratonin and dopamine- important in regulating limbic system- controls emotion

when monamine reduced - effects link to depression

MONOAMINE- WHAT IT DOES

Serotonin- regulates neurotransmitters- responsible for mood, well being stomach and memory- linked to low mood, reduced apetitie

Noradrenaline- hypotalamus and hippocampus- heart rate concentration and attention- disruption in sleep patterns

dopamine- responsible for motivation, reward

MEYER ET AL - COMPARED 17 PATIENTS WITH DEPRESSION AND OUND THAT DEPRESSED PATIENTS HAD SIGNIFICANTLY HIGHER MONOAMINE OXIDASE LEVELS THEREFORE MONAMINE LINKED TO DEPRESSION

Genetic explanation of mental illness- MEDICAL MODEL

CONCORDANCE AND PROBANDS

idea that the more genes two ppl share the similar the behaviour- characteristics have a genetic basis

similarity based on correlation - concordance tests

identify ppl with disorder probands and assesing relatives of proband

ie family studies

GENETIC EXPLANATIONS OF DEPRESSION

Family studies- children have a risk of developing bipolar disorder if parents have bipolar disorder

i.e child has 4.4% risk of being diagnosed with bp if parent has bp in comp with 0.63 % of population

MEDICAL MODEL- BRAIN ABNORMALITY

Refers to how a mentally ill patients brain differs from a neurotypical perSons brain

If certain areas of the brain develop abnormally or become damaged through illness or injury, then the functions that those areas control may also be affected

i.e amygdala responsble for feelings of fear

BRAIN ABNORMALITY EXPLANATION FOR MAJOR DEPRESSION

The limbic system part of the brain is different in severe depression- in terms of grey matter and levels of activity in areas of brain

LIMBIC SYSTEM

amygdala-- changes in activity-increase in activity with sad stimuli- decrease with positive- suggets amygdala regulates emotions

Hippocampus- significantly smaller in depression- more severe more loss of grey matter - could explain why people with depression process emotionally charged memories in dysfunctional ways

SHELINE- FMRI -AMYGDALA MORE ACTIVE IN THOSE WITH DEPRESSIONTHAN CONTROL - AFTER ANTIDEPRESSANT DRUGS THERE WAS A REDUCTION OF ACTIVITY IN AMYGDALA

GOTTESMAN ET AL - aim

aimed to use a larger sample than previous research to investigate the likelihood of being diagnosed w/ sz bp or another disorder if 1 or both of parents have been diagnosed with one of these serious mental illnesses

LOOK AT GENETIC LINKS BETWEEN CLOSE RELATIVES

- WANTED TO SEE IF 2X COULD INCREASE RISK

GOTTESMAN METHOD

used secondary data from a database from a cohort of the DANISH population

SECONDARY DATA FROM

-THE DANISH CIVIL REGISTRATION SYSTEM- info on all born in DENMARK- inc fam- selected from specific years

-DANISH PSYCHIATRIC CENTRAL REGISTER- info on 650,000 patients who were admited into psyc hosp

nearly 4 million ppl from denmark were studied - split into 4 groups - 2 were control

GOTTESMAN- GROUPS

both admited

1 admited

cleaned pop

no data on diagnosis

GOTTESMAN PROCEDURE

data on each offspring linked w/ parents

using DANISH CIVIL REGISTRATION SYSTEM- researchers were able to establish who their parents were and also see if they were on the PSYCHIATRIC REGISTER

GOTTESMAN RESULTS

SCHIZOPHRENIA

GROUP A- BOTH 27% - 4X HIGHER THAN 1 PARENT AND 32X WITH NEITHER

BIPOLAR

68% OF PPL WITH BOTH SZ HAD BEEN ADMITTED W/ A PSYC DISORDER

44% WITH BP W/ BOTH

COMP WITH 12% AND 14% GENERAL POP

GOTTESMAN CONC

SIGNIFICANTLY INCREASES RISK

SUPPORT GENETIC EXP

NOT 100% THEREFORE GENETIC NOT ONLY EXP

USEFUL- GENETIC COUNSELLORS MAY ADVISE WHEN RECREATING

MISUSE OF DATA- COULD BE EVIDENCE OF EUGENICS

VALIDITY- GOTTESMAN

gottesman basec on icd- valid to use

RELIABILITY- MEDICAL MODEL

Brain abnormality MRI scans- sheline- reduced activity

SAMPLING BIAS-- Gottesman

Large sample- generalised to danish citizens

only included hospital admisions-- only for severe cases

ETHNOCENTRISM GOTTESMAN

View may not apply to all cultures- other cultures may hold the belief that illness cmes from religious pardigms

MEDICAL MODEL- NATURE V NURTURE

Genetic exp- nature

brainabnormality and biochemical- nurture- abnormalities can occur to life events i.e brain damage or drugs can affect neurotransmitter activity - nurture

diathesis-stress model- not seperate but interact - genese create a vulnerability for disorder- diathesis -

which will only develope if a life event triggers it - stress may be born with genes but not have trigger

free will vs determinism MEDICAL MODEL

MEDICAL MODEL- DETERMINISTIC- mental illness determined by factors such as neurotransmitters, genes and brain structures- beyond personal control

freewill- some people with sz teach themselves how to control their hallucinations i.e listening to loud music to drown out the voices

MEDICAL MODEL REDUCTIONISM/ HOLISM

REDUCIONIST- breakdown complex behaviour reducing it to simple form i.e genes

holistic- diathesis stress model

USEFULNESS- MEDICAL MODEL

allowed for modern day treatments

i.e drug treatments based on knowledge of abnormal levels of neurotransmitters i.e SSRIS inhibit levels of seratonin

useful to know how genetics influence development of illness - professionals can advise of risk

SOCIALLY SENSITIVE MEDICAL MODEL

GOTTESMAN- idea that could lead to eugenic- idea that reproduction prevented in certain groups- damage to gene pool

Individual- caused by factors like biology and personality

S- allows us to change behaviour by developing treatments

W-reductionist

BIOLOGICAL TREATMENT FOR DEPRESSION

ELECTROCONVULSIVE THERAPY- ECT

used today for those who are an immediate danger to themselves

full medical examination is carried out inc heart rate + blood tests

then patient is given general anaesthetic + muscle relaxant to prevent physical injury + oxygen to prevent brain damage

when unconscious the doctor will turn on ect machine to initiate electrical current

electrodes placed on head and small amount of current s passed

research suggests the electric current changes the actiity of the neurotransmitters involved in depression i.e serotonin and dopamine / blood flow is stimilated

USEFULNESS + EFFECTIVNESS OF ECT

only treats severe conditions

used when drug therapy has not worked

EFFECTIVNESS

- relativey high relapse rate- many develop further depressive symptoms

side effects- headaches , aching muscles- feeling dizzy and being distressed

BEHAVIOURIST EXPLANTION OF MENTAL ILLNESS

mental illness is learnt

- determined by external events

classical conditioning -PAVLOV

operant conditioning-

SLT- May develop an illness because they observe someone else displaying certain 'abnormal' behaviours and imitate those behaviours

BEHAVIOURIST PERSPECTIVE OF MAJOR DEPRESSION

Classical conditioning-

placed dogs in a cage and classically conditioned them to expect a shock after they heard a tone- then moved- found the dogs wouldnt try to escape even though they could

learned helplessness- early experiences of lack of control people may respond in such way later on in life- respond with depression

operant conditioning- if someone passes away- no longer recieving positive reinforcment-

those around someone with depression may encourage behaviour by giving attention to depressed individual when show suymptoms

STRENGHTS AND WEAKNESSES OF BEHAVIOURIST EXPLANATION

STRENGTHS

based on observations using scientific methods- high alidity- support psyc as science

WEAKNESS

- fails to explain causes of endogenous depression with no trigger

COGNITIVE EXPLANATIONS OF MENTAL ILLNESS

Focuses on internal processes like memory and attention

attributes faulty thinking to mental illness

about individuals interpretation of an mental illness

looks at internaal processes- faulty and irrational internal process are cause of mental illness

irrational thinking-

champions treatments that involve changing individual cognitions so they are more rational

COGNITIVE EXPLANATION OF MAJOR DEPRESSION

depression- negative thoughs

becks cognitive triad argued ppl make cognitive errors

- this triad involves an individuals pessimistic view of

onself

the future

the world

i.e indivdual believes they are worthless thinks future will be negative and that everyone ahtes thems- NEGATIVE THOUGHTS FORM NEGATIVE SCHEMAS LEADING TO SYSTEMATIC COGNITIVE BIASES IN THINKING

THESE STEM FROM EARLY LIFE

BECKS DEPRESSION INVENTORY

STRENGTHS AND WEAKNESSES OF COGNITIVE EXPLANATION OF MENTAL ILLNESS

STRENGTHS-

takes into account mental processes -both nature and nurture- becks depression inventory looks at childhood experiences

effective CBT

WEAKNESS

- doesnt provide reason why cognitive biases are formed

difficult to establish cause and effec

not observable behaviour- difficult to prove therefore not scientific

PSYCHODYNAMIC EXPLANATION OF MENTAL ILLNESS

attempts to explain in terms of UNCONCIOUS FORCES, CONFLICT AND MOTIVATIONS

THE TRIPARTITE PERSONALITY

ID EGO SUPEREGO

ID PLEASURE

EGO - REALITY

SUPER EGO -MORALITY

EGO DEFENCE MECHANISMS - USE DEFENCE MECHANISM TO HELP COPE WITH CONFLICT IN UNCONSIOUS MIND

REPRESSION - PUSHING AWAY UNWANTED THOUGHTS - DISPLACEMENTS - UNCONCIOUS FEELINGS DIRECTED TOWARD SAN OBJECT

REGRESSION- RETURNING TO AN EARLIER STAGE OF DEVELOPMENT

PSYCHODYNAMIC EXPLANATION OF MAJOR DEPRESSION

LOSS AND DEPRESSION

- anger turned inward

originates in childhood- represses feelings in unconcious- depression occurs in adulthood - loss experienced again in adulthood triggers this

bowlby- attachment theory- loosing someone close to you - creating vulnerability - harder to cope with future losses - cant understand experience when young- UNRESOLVED FEELINGS-- triggered by adulthood- depression

coffino - longitudiinal study STRONGEST PREDICTOR OF DEPRESSION OF ADULTHOOD DEPRESSION WAS LOSS BETWEEN 5-8

STRENGTHS + WEAKNESSES OF PSYCHODYNAMIC EXPLANATION

STRENGTHS

- looks at nature nurture

weakness

- unfalsifiable- lack scientific validity can not be proven / observed

determinsitic

SZASZ AIM

book + essay - the myth of mental illness - CHALLENGED MEDICAL MODEL - CLAIMED MODERN PSYCHIATRY - CONCEPTUAL ERROR

aimed to challenge the concept of mental illness

rejected the psychiatric treatment

didn't see mental illness as a medical problem

szasz believes there a no mental disorders- concerned with increaisng number of disorders-

slaves running away were believed to have DROPADOMANIA

BELIEVES SHOULD NOT BE TREATED WITH PSYCHOTICS

IDEA OF HOW IT WAS ABOUT CONTROLLING PEOPLE- SHOULD USE PHYSICAL ILLNESS TO EXPLAIN ILLNESS

PSYCHIATRIC DIAGNOSIS IS ABOUT POWER

Szasz method

article which reviews changes in beliefs and concepts surrounding mental health

Szasz key points

Mental health is a myth, not disease

Medical model is now the only way of dealing with people who behave differently

Government decides what illnesses exist- control regulation and funding

Economic issues- big business in pharmaceuticals and treatment

Mentally ill people are trying to cope using whatever way they can- not passive players to biology

People deprived of freedom to behave in way they choose to

Need to understand reasons by respect, understand and help- not diagnoses under a loose fitting definition

Szasz why medical model is unacceptable

Causes of mental illness- no identifiable cause like infection, nutritional deficiency. Mistake to look for biological causes

No alternative legal approach- gov involved- not based on science

Denies freedom and responsibility to behave- coerced and forced into diagnosis and treatment-unethical

Diagnosis subjective- judgement

Dehumanising-ignore suffering- labels constructed due to medicalisation

Other ways to treat it- medical only suppress

Szasz conclusions

Psychiatry is a pseudoscience and mental health is a myth- mental health in eye of beholder and wrong to treat mentally ill as sick patients

Should have rights to control own lives

Alternatives to medical model

Now legal not medical in USA

Szasz 1960

care for mental health- mental health facilities or private practicioners

Mental patients treated no better than prisoners

Not a disease like physical

Doesn't exist- foolish to look for cures and causes

Szasz 2010

All healthcare regulated with public money

IF medicine relies on consent for treatments of physical- why not mental

Politically/legally labelled a disease

False belief all can be treated accurately

People need to be understood- not given drugs