Mental Illness - Final Exam

 What are the 2 types of commitment to a mental hospital?  Which type of commitment is the most common?

• Voluntary *most common

• Involuntary

 What is Status Resource Theory as applied to being committed to a mental hospital?

• Research supports that people with more resources are more likely to be admitted voluntarily to a hospital, and those who have less resources are more likely to be admitted involuntarily

What was the main finding of Rosenhan’s study of “pseudo” patients who gained admittance into a mental hospital?

Highlights the importance of diagnosis as a form of labeling and the outcome of labeling

 Who is more likely to be committed to mental hospital?  There are two viewpoints.  What are those viewpoints?

• Someone with a lower SES or “marginal” to society and are least likely to resist labeling is more likely to be committed. (Research by Gove and colleagues)

• Scheff: Those who are of a lower SES are more likely to be committed (Most research supports this finding)

 What is a total institution?

A place of residence and work where a large number of like situated people, cut off from the wider society for an extended period of time, and together lead an enclosed, formally administered round of life

What are some examples of a total institution?

All aspects of life are controlled and conducted in the same place, and everyone is virtually treated the same

Which type of mental institution tends to treat the patients better?  Private or Public Hospital?

Private Hospital

What are the 4 types of adjustment to a total institution?

• Situational withdrawal (withdrawing from others, the rules, not participating)

• Rebellion (rebelling against the rules, “bucking” the system)

• Colonization (using experiences in the outside world to demonstrate the desirability of life on the inside)

• Conversion (following the rules and becoming the model patient)

What are the 5 characteristics of the good patient or the good patient model?

• Believe that recovery is possible

• Recognize that he or she is mentally ill and needs treatment

• Trust and have faith in the therapist and by extension the rest of the staff

• Conform willingly to life at the hospital

• Accept the treatment that is prescribed

  What is stigma?

• Stigma develops as a result of social interaction with others and can have devastating consequences

• It involves a negative social judgment about a person based on some attribute or character

• This judgment generally results in exclusion of the person, blaming the person for their current state, devaluation, and discrediting the person based on the attribute or character

What are the 3 types of stigma, according to Goffman?

• Physical deformity 

• Negative character or character blemish (this would include someone who is mentally ill, criminal, or other deviant behaviors)

• Race, ethnicity, religion, nationality

 There are 3 goals that are achieved by stigmatizing others.  What are these goals?

• Exploitation and domination or keep people down

• Enforcement of social norms, which involves keeping people in line

• Avoidance

What is the main reason why people are stigmatized, according to Link and Phelan?

Enforcement and social norms

What were the general community opinions on mental health in the 1950’s?

community opinions toward the mentally ill were negative and rejecting

What were the general community opinions on mental health post 1950?

• People who are or were hospitalized for a mental disorder are subject to stigma and discrimination

• There are more tolerant views of the mentally ill

• The community does view the mentally ill negatively, but does not discriminate them

• Having a close association with someone who is mentally ill or was a patient leads to a more positive view

The key to adjusting to the community after being in the hospital involves 4 elements.  What are those elements?

• Material support

• Social support

• Series of spontaneous social interactions with people

• Patient should have control over new situations

What are deflecting strategies to resist stigma?

 Involves a cognitive process, where individuals acknowledge that their identity is stigmatized by others but do not identify with the stigmatized status

What are challenging strategies to resist stigma?

Involves a proactive engagement with behaviors and activities that serve to reduce the stigma related to the deviant behavior in question

 There are 3 conditions that must be met before we can establish whether someone is able to use resistance strategies.  What are these 3 conditions?

• Individuals must acknowledge that they have, or others believe that they have, a mental illness

• Individuals must be aware that the illness could become public knowledge and others can define their mental illness or define someone as mentally ill 

• Individuals must understand the cultural meanings attached to the mental illness

 What are the 5 distinct reactions that individuals might have to cultural stereotypes, according to Peggy Thoits?

• Agreement: individuals agree with the broad conceptualization of mental illness and endorse them as self-descriptive, or in other words, self-stigmatized

• Rejection: Individuals reject the cultural conceptualizations entirely by challenging, educating, and confronting these beliefs on behalf of themselves and others with similar labels

• Minimize: individuals are aware of cultural views about mental illness but attempt to minimize their effect by distancing themselves from definitions of illness

• Withdrawal: Individuals will avoid social situations and interactions with others who have mental illnesses

• Self-restoration:Individuals will pull back from behaviors or interactions where they might fair based on experienced devaluation and discrimination

What is the self-concept?

 An entity that contains how an individual sees him, her, or their self as a physical, social, and moral human being.

 What are the 4 principles of the self-concept?

• Involves reflected appraisals: You come to see yourself as others see you.

• Involves social comparisons: You develop criteria where you judge yourself as inferior or superior compared to others.

• Reference groups: Provides the norms that become internalized and results in the standards by which the self is compared.

• Self-attributions: Drawing conclusions about what we are like by observing our behavior and subsequent outcomes.

• Psychological centrality: The structure of the self. The self is arranged in a hierarchy of importance

  What is the looking glass self?

The development of the self from our impressions of how others view us.

What is self-esteem?

 a person's overall sense of self-worth or personal value

What is mastery?

one's sense of control over one's life

What is a self-enhancement hypothesis?

 Protecting or increasing self-esteem

What is a self-maintenance hypothesis?

 Behaviors work to maintain a negative self-esteem

What is identity theory?

Social structure, or one's location within the social structure hierarchy, impacts the individual, and of how the individual impacts social structure

 role conflict

a conflict between or among the roles corresponding to two or more statuses fulfilled by one individual

role ambiguity

the lack of clarity in understanding the actions to be taken to achieve proposed individual goals

role overload

when an individual fulfills multiple roles simultaneously and lacks the resources to perform them

role exit

When an individual stops engaging in a role previously central to their identity and begins the process of establishing a new identity

What is social identity?

people's self-categorizations in relation to their group memberships

What is the Twenty Statements Test?

Used to measure self-concept

Which self-concept is related to better mental health?  One based on group membership or one based on individualism?

Group-membership

What three sectors do people seek help?

• The primary care and outpatient medical sector

• The general hospital inpatient and nursing home sector

• The specialty mental health sector

Which sector treats the most patients?

70% treated in primary medical care and outpatient care

There were several changes that led to the deinstitutionalization of mental health patients.  What were those changes?

• The discovery and use of medications (psychotropic drugs) to treat patients (1950’s).

• The passage of the National Mental Health Act of 1946.

• The increase in the numbers of outpatient clinics, general hospital inpatient services, and nursing home beds for the mentally ill.

• The enactment of the Mental Health Study Act (1955), which established the Joint commission on Mental Illness and Mental Health.  This commission was to analyze and evaluate the needs of the mentally ill.

• The passage of the Mental Retardation Facilities and Community Mental Health Centers Construction Act (1963).

What two groups of people in the community were most targeted to prevent mental illness?

The poor and children

What did the 1975 amendments to the Community Mental Health Center Act require?

Community treatment programs include the creation of halfway houses to provide short-term or long-term living arrangements

Most courts use psychiatrists and expert testimony to determine whether a person is dangerous.  Psychiatrists make predictions on whether someone is dangerous.  What is the problem with prediction?

Physicians are biased because they are programmed to find an illness even when one is not there

M’Nagthen Rule

Must be proved that during the act a person did not know what he/she was doing, did not know it to be wrong due to mental illness or a “defect of reason.”

Durham Rule

 Accused person cannot be held responsible if the act was the result of a mental illness

American Law Institute (ALI) Rule:

Accused person is not responsible if the act is the result of mental disorder or the individual lacks the understanding to know his act was criminal and lacks the understanding and ability to conform to the law

Insanity Defense Reform Act

The accused, at the time of the act, is unable to understand the nature or wrongfulness of his or her action. The defense must provide clear and convincing evidence