Mental Illness First Exam Definitions

reification

process by which the effects of political arrangement of power and resources start to seem like objective facts; process of treating abstract social concepts, relations, or things like mental illness, as if they were concrete, objective things

3 examples of reification

1. the effects of unregulated tech oligologies become social media addiction

2. climate catastrophe caused by corporate greed becomes a heat wave

3. the effect of struggles between labor and corporations combined with high energy prices becomes inflation

“A crisis that affects mental health is not the same thing as a crisis of mental health.”

a crisis that affects mental health could be something like covid: isolated people, large pandemic, inevitably affected most of the population’s mental health; a crisis of mental health - first need to ask what is causing this, ‘got run over by a car syndrome’, in order to solve the crisis of mental health you need to find the root issue or underlying causes

‘got run over by a car syndrome’

analogy to explain why there needs to be questions asked about mental health crisis; if someone is driving through a crowd and running people over, it’s not smart to declare a ‘got run over by car syndrome’ and look for that root cause, but instead need to stop the guy from running people over with a car

medicalization

process by which something gets framed as a primarily medical problem; shifts the terms in which we try to figure out what caused a problem and what can be done to fix it, often puts focus on the individual as a biological body at expense of factoring out larger systems and conditions

Does he (Szaz) believe that mental health is a thing?

no, says its not a literal thing so therefore can only exists/appear in theories and as self evident causes of events; if it is a brain disease call it that, if not then it’s a problem in living and medicine is the wrong tool

How is it a myth in the same sense that witchcraft is?

they both (mental illness and witchcraft) appeared as self evident causes of a vast number of events; familiar theories are in the habit of posing as objective truths

What happens when psychiatry finds biology?

you can’t define a problem in moral terms and then solve it with a medical instrument

How was homosexuality removed from the DSM as a diagnosis?

1973 removed by a vote from the APA under political pressure, not laboratory finding

The norm, remedy, mismatch

norm - psychosocial, ethical, and legal; “excessive repression” among other symptoms, psychiatric opinion that only a mentally ill person would commit homicide is a legal concept used as a health norm

remedy - medical, claims to be value free; drugs, hospitalization, therapy

mismatch - defining a problem in moral terms and trying to solve it with medical instruments

what does psychiatry measure

diagnoses - you have it or you don’t

what does sociology measure

distress - measured by degree

How does Horwitz organize sociological work?

question 1 - what social conditions produce distress

question 2 - (his question), how does society define and respond to it, asked empirically

How are scales used?

used in community samples, CES-D asks 20 questions about the past week, provides a score not category, BDI is a continum scoring across 6 categoties 1-10 with up to 40

Examples of how DSM III medicalized human conditions

• social phobia was ‘relatively rare’ condition when it first entered the DSM, from 1-2% in early studies to 13% by 90’s/decade later

• ADHD in children: estimate of 5% diagnosed upon introduction, now 11.4% in 2022 with over 50% on medication

• pediatric bipolar: virtually unknown to youth, thought to be mid-life condition, 40 fold increase in children treated from 1994-2003

• antidepressant use: not well documented, nearly tripled from 1988-2000

(Scull) What are three explanations for the same event? (explaining madness)

supernaturalism - demons, evil spirits, etc,. all astrological causes like eclipses, lunar phases; cause is outside the body

somatogenic - rooted in physiological dysfunction like brain injury, chemical imbalance, hereditary, direct answer to medical model; cause is inside the body

psychogenic - traumatic or stressful experience, direct ancestor of psychotherapy; the cause is in the life

The Chicago School Landmark

mapped psychiatric hospitals admissions in Chicago to reveal how sever mental illness clusters in specific urban environments, showed that rates of diagnoses mental disorders dropped sharply from the center of the city outward; argued that poverty and social isolation in urban core actively fostered mental breakdown and distress

How does Scull think about the reality of mental health

views it as a real human suffering with profound physical and behavioral consequences, but rejects modern biological reductism that treats it as a simple brain disease akin to a broken leg

Deinstitutionalization

process of releasing people from long term institutional care and shifting their treatment and support to community based settings

reliability

producing consistent and repeatable results under same exact conditions: sat example; consistency

validity

extent to which research method or measurement accurately reflects the true reality it intends to measure; correctness

false positive

result that indicates a given condition exists when it objectively does not

specificity

contextual, historical, and situational boundaries that shape social life and theory

harmful dysfunction

any social pattern, structure, or institution that disrupts the stability, operation, or balance of society

true prevalence

the actual rate of disorder in a community, including those not in treatment

clinical prevalance

people currently being treated for mental illness

comorbidity

co-occurence among mental disorders within individual or group, complicates research design

organic solidarity

form of social cohesion where people rely on each other because they each have specialized roles and different jobs

anomie

social condition/instability resulting from breakdown or loss of social norms, guidance, can lead to higher rates of suicide

forced division of labor

societal rules and constraints assign individuals to specialized roles against their natural aptitudes and free choice, occurs when external inequalities prevent natural matching and people are pushed into occupations by force rather then by merit

unequal opportunities —> constrained choices —> forced division of labor

the sick role

role - what a person is expected to do, given who they are taken to be; you get exemption, absolution of blame, can also be obligation; you owe a desire to get well and seek competent help

legitimated deviance

behavior that violates traditional social norms but is officially or culturally accepted, normalized, or legalized by institutions like the state or the market.

labeling theory

states that deviance and crime are not inherent acts, but rather products of how society reacts to and labels behavoirs.

the Great Confinement

term coined by Foucault, to describe mass institutionalization of the insane, poor, and social deviants in 17th century Europe.

What kind of institution was the Hôpital Général?

not a medical establishment, rather a semi-judicial structure or administrative entity that courts, decides, and judges (who is mad)

What was the population in institutions such as Hopital?

foucault estimated 1% of Paris’ population but not true; poor, mentally ill, sex workers, abandoned youth

How did ‘sloth’ fit into this?

idleness was believed to be the chief sin because idle men do not feel the need to work, those who were abnormal did not want to work, sloth is then seen as chief sin bc bad not to work

Three psychiatrists, same patient, same information, agreement about 20% of the time; reliability and validity of dsm

issues with reliability in DSMII therefore lacked scientific validity, medical boards during the war had drastically different rejection rates for enlistment as there was much disparity on psychiatric ground, didn’t agree on who was ill because there was no set definition, too subjective

what was DSMIII’s innovation?

provided a checklist of symptoms that should be present in order to justify diagnoses along with expanded definitions, gave people across the country a new language with which to interpret their daily experiences; answered the issue of reliability with previous DSM, also got rid of word ‘neurosis’ moved it to parenthesis

Why did Spritzer get the job

he had an established med school career and when he turned to research at Colombia he was given the job because no one else wanted it/it wasn’t considered that important

5 limitations of DSM/ICD

1. categorical

2. high comorbidity

3. lack of objective biological validation

4. cultural and contextual bias

5. labeling and stigmatization

six spectra

1. categoties on continuum

2. symtoms overlap

3. heterogeneity

4. comorbidity

5. contiuum of severity

6. no clear boundaries

Prevalance

prevalence = rate; sociologists measure and look for true prevalence and psychiatrists look for clinical prevalence, psychiatric epidemiologists look for true prevalence and it’s long term effects

process of creating dsmIII

Spritzer put together a group of psychiatrists who saw themselves as scientists, they basically argued in a room for definitions and the loudest voice often won, ‘data-oriented’ people, 25 committees, very little biological basis for diagnoses

true prevalence vs. clinical prevalence

true prevalence can’t be measured through clinical surveys, need to take into account people’s socioeconomic statuses, focused on using direct surveys of community populations, need large population samples, biggest struggle is constructing an instrument that validly distinguishes disordered from non disordered individuals

Horwitz and Wakefield, Loss of Sadness - what is their basis thesis

advocates for an edit of the DSM, argues that intense feelings after extreme life changes like death are normal and don’t always constitute a disorder, so by failing to take into account normal sadness modern psychiatry overdiagnoses depression and unnecessarily medicalizes normal human emotions

what was the criteria for major depressive disorder

required five out of nine symptoms to be present during a two week period, must include either depressed mood or diminished interest/pleasure, however the symptoms aren’t accounted for by bereavement more than two months

bereavement exclusion

the diagnoses in DSM does not account for bereavement no more than two months, the problem is that these symptoms might naturally occur for more than the time period and it’s not a disorder, leads to wrong diagnoses