historical views of mental illness

perspective 1

prehistoric view

what did the prehistoric view believe about mental health

mental health issues was due to the supernatural - demons possessing someone.

what was the treatment for mental health issues in the prehistoric view

‘trepanning’ - drilling a hole into someones skull to release the supernatural spirits

was the prehistoric view scientific

no, as we cannot objectively see the spirits leaving a persons skull

was the prehistoric view reductionist

yes, as it believes it is only spirits inside someones head that is causing mental health issues instead of other factors like environment.

was the prehistoric view useful

yes, because the approach provided a starting point for the role the brain has in mental health. no, because the application of trepanning may do more harm than good. 

perspective 2

400bc ancient greece

what did the 400bc ancient greece view as the cause of mental health issues

mental illness was due to an imbalance in the four humours (blood, phlegm, yellow bile, black bile), e.g. excess of yellow bile makes a person impulsive, excess of blood makes a person courageous. 

what was the treatment for mental illness in 400bs ancient greece

adding or removing a humour, for example ‘purging’ was the removal of excess blood. 

was the 400bc approach to mental illness scientific

yes, as it is quantifiable (the amount of each humour taken from a person). 

was the 400bs approach to mental illness reductionist

yes, as it only considers the body’s chemistry for a reason why people are disturbed, not other factors like environment. 

was the 400bs approach to mental illness useful

yes, as it got humanity thinking about factors internal to the body as reasons for mental health issues. 

definition 1 of abnormality

statistical infrequency - behaviour rarely seen in the general population is considered abnormal

strength of defining abnormality through statistical infrequency

it is scientific as it is a quantitative measure of behaviour, and therefore objective so can be applied in a reliable way

weakness of defining abnormality through statistical infrequency

it may not be a valid definition as those with the lowest and highest IQ scores are abnormal but may function perfectly in society, so a label would not be useful for them. additionally, cut-off points for normal or abnormal things are often arbitrary

clinical example of something that is statistically infrequent

schizophrenia only occurs in 1% of the population.

definition 2

deviation from the social norm - behaviour that can be seen as a departure from what one society or culture deems acceptable.

strength of definining abnormality through deviation from the social norm

considers the desirability of a behaviour and is therefore more useful e.g. some behaviours may be rare but desirable and so wouldn’t be classed as an illness.

weakness of definining abnormality through deviation from the social norm

abnormality can therefore not be considered universal due to cultural differences in social norms

clinical example of something that is a deviation from the social norm

hearing voices may be perceived as abnormal in UK culture, but in other cultures it could be seen as talking to spirts of ancestors and the person would be well-respected because of it. 

definition 2

maladaptiveness - failure to function adequately. when a person’s way of thinking, emotional responses or behaviour is dangerous or prevents them from functioning well e.g. negatively affecting relationships, ability to work, injury to self, etc

strength of defining abnormality through maladaptiveness

this recognises the subjective experience of the individual and whether or not they are suffering, consequently it has face validity when trying to diagnose someone with an illness. 

weakness of defining abnormality through maladaptiveness

this definition is not scientific as it is subjective – how people define ‘failure to function’ differs meaning that the definition can’t be reliably applied. 

clinical example of something maladaptive

when panic attacks stop you from leaving the house or obsessively washing hands leads to persistent lateness to work. 

why is being labelled abnormal useful

a person can receive medical or psychological help. a person can receive wider assistance, such as benefits from the state if a person can’t work. 

why does being labelled abnormal add to academic knowledge

it helps people understand their own experience and feelings. it allows others to understand behaviour and demonstrate empathy.

why is being labelled abnormal socially sensetive

can lead to labelling as people may begin to see their behaviours as symptomatic of the illness, even if its unrelated. they may lose their own identity and start seeing themselves in terms of their diagnosis alone. 

why is being labelled abnormal ethnocentric

not all cultures will have the same definition of abnormality, so then may not receive the same treatment or help consistently.

what is the DSM

diagnostic and statistical manual of mental disorders. it is used by psychiatrists to classify abnormal behaviour and diagnose patients through clinical interviews, psychological testing, observation and physiological testing. it was created by the american psychiatris association and it on its 5th edition. it contains descriptions, symptoms and other criteria to reliably diagnose disorders in three catagories - psychotic, anxiety and affective. 

what is the ICD

international classification of diseases. it is used for clinical and research purposes to define diseases, disorders, injuries and other related health conditions, including mental disorders through clinical interview, observation, psychological and physiological testing. it is produced by WHO and used widely outside the US. it is on its 11th edition, combined with the DSM to create a coding for disorders globally. 

what is useful about the DSM and ICD

they allow people to be diagnosed and treated, as well as improve understanding of mental health issues in society

what is not useful about the DSM and ICD

may not get an accurate diagnosis, so you will be mistreated and may get a label as well as the stigma that comes along with it.

aim of rosenhan

to test the hypothesis that psychiatrists cannot reliably tell the difference between people who are sane and insane

method 1 of rosenhan

eight pseudo patients (sane people pretending to be mentally ill) telephoned 12 psychiatric hospitals and complained they were hearing a voice saying ‘empty’ ‘hollow’ and ‘thud’. they also did not wash for about a week before coming in for an appointment with a psychiatrist. once admitted into hospital, they acted completely sane and recorded observations from the ward. the pseudo patients had to get out of the hospitals themselves. as the staff did not know they were being observed, it is a naturalistic participant observation.

results from method 1

7/8 pseudo patients received a diagnosis of schizophrenia. 1/8 received a diagnosis of bipolar.
patients remained in hospital for 7-52 days before being released with ‘schizophrenia in remission’
‘stickiness of labels’ - where normal behaviours are deemed a symptom of their mental illness label, for example queuing for lunch was seen as ‘oral-aquisitive syndrome’ and writing in their diary was seen as obsessive writing behaviour. 
pseudo patients 
88% of nurses completely ignored by patients whereas in a comparison study at Stanford University 100% of professors stopped to engage with the student
patients often experienced verbal abuse from staff
staff were on the ward for under 7 minutes per day 

method 2 of rosenhan

in a secondary study, rosenhan told the hospitals about the pseudo patients and said he would send more in. he didn’t. staff were asked to rate on a 10-point scale for each patient that tried to be admitted the likelihood of them being a pseudo patient.

results from method 2

41/193 patients were suspected to be pseudo patients by 1 staff member
19 were rated to be sane by more than one member of staff

how can rosenhan’s research be considered socially sensetive

it shows that mental hospitals do not work, so people may lose faith in psychology and question their diagnoses. it also shows how labels work and the stickiness of then, that normal behaviours are dubbed symptoms of their mental illness.

in what ways is rosenhan’s research unethical

staff did not have the right to withdraw from the study as they did not know they were taking part (no informed consent also). they also experienced massive amounts of deception as they did not know the pseudo patients weren’t actually mentally ill and that they were being tested/observed, and that rosenhan didn’t send pseudo patients in part 2. they also did not have protection of participant as they lost credibility when the results came out. they did have a debrief, though. the reason for breaking ethics was that it made sure their reactions to mentally ill patients were genuine, but a negatie side of breaking ethics is that it harms the reputation of psychology which could lead to less funding in the field.

how could rosenhan’s study be seen as ethnocentric

all the hospitals were in the US, so only the DSM was used to diagnose them. there may not be the same results if it was done in a place that used the ICD, for example.

benefits of field experiment for rosenhan

high ecological validity due to it being an authentic hospital staff and diagnostics, however it would be hard to replicate as there is no contorl over EVs.

what does rosenhan tell us about the validity of diagnosis

validity is questionable as healthy people can gain the label of being mentally ill from unsubstansive symptoms, meaning the system is not internally valid (not accurate in diagnosing mental illness)

what does rosenhan tell us about the reliability of diagnoses

there are high levels of reliability in the system as 7/8 pseudo patients got the same diagnosis of schizophrenia in part 1, and in part 2 19 patients were labelled as sane by at least 2 members of staff, showing a level of inter-rater reliability. system is consitent, but not valid (accurate).

what does rosenhan tell us about the stickiness of labels

queining up for lunch, getting steps in and writing was classes as symptomatic of their mental illness when these are normal behaviours, showing how labels attach themselves to many parts of a persons behaviour that are nothing to do with mental illness.

could rosenhan’s study be considered useful

yes, as it raises awareness of a problem in the mental health system - that the system is not accurate. however, it is not useful because it is ethnocentric so doesn’t tell us about systems outside the US.

affective disorder

a disorder that affects mood, for example depression. symptoms include loss of interest in hobbies, insomnia/hypersomnia, over/under-eating, and the creation of a suicide plan.

anxiety disorder

a disorder involved with excessive feelings of stress or fear, for example phobias. symptoms include a response disproportionate to the stimulus, irrational fears, avoding the stimulus or being close to it but whilst feeling extreme stress.

psychotic disorder

a condition where a person loses contact with reality, for example schizophrenia. symptoms include auditory hallucinations, delusions, and disorganised thoughts and speech.