FL

class 2 week 1 lecture recording

Reflection and Discussion Prompts

  • The instructor encourages showing evidence of reading and connecting material across classes.
  • Emphasis on using more examples and applying ideas to answers, questions, or discussions.
  • Prompt questions to stimulate critical thinking:
    • What does this material make you think about?
    • What does it make you feel uncomfortable?
    • How come?
    • Do I agree with this? Do I not? What do I think?
    • The goal is to push you to reflect deeply on the material.

Course Logistics: Presentations and Scheduling

  • Presentations: the sign-up process is available (the sign-up page is up).
  • Group formation and contact info:
    • If you don’t know the people in the group, share contact information.
    • Once a group reaches four people, you can’t add more members.
    • Some groups have only a few members; some have zero; group sizes will be fluid.
  • Presentation dates and changes:
    • Some students may present on September 17; others on November 11.
    • Schedules can change; you can update the instructor if needed.
  • Documentation and tracking:
    • Paper documents listing who is doing what are needed; changes should be tracked.
  • Optional approach:
    • You can plan and discuss among yourselves, but keep the instructor informed of changes.

Conceptual Framework: Medicalization and Mental Models

  • Recap: last class covered multiple rounds/topics; readings were assigned but not discussed in class.
  • Core idea: medicalizing internal processes (psychological or physiological) using a mental model of illness that can be treated.
  • Examples and domains:
    • Cancer within oncology as a reference point for illness conceptualization.
    • Burnout at work as an example: explainable via internal processes and illness models, not solely through external/workload factors.
  • Distinction in explanations:
    • Tends toward psychologicalization — explaining outcomes via internal processes rather than observable behavior alone.
    • Emphasis on resilience deficits in the individual as a contributor, rather than solely social determinants.
  • Caution about social factors:
    • Need to be mindful not to overly discount social determinants or environment when explaining distress.

Biological vs Descriptive Debate: Core Arguments

  • Hypothetical scenario for certainty:
    • If mental illness were a fully proven biological disorder with 100% certainty, and if the world ended tomorrow with a possible rebuild in 2000 years, there would need to be a single driving biological factor detectable across time.
    • The material argues that this is not the case for mental illness as discussed in this course.
  • Descriptive nature of mental illness:
    • Mental illness is described by symptoms; there is an assumption of an underlying biological component, but it is not proven to be the sole cause.
  • Diagnostic workflow:
    • We should assign or translate categories to specialists for assessment and separation of conditions.
  • Reference to Rosenhan (1963/1973):
    • Rosenhan’s study involved normal people acting as pseudo-patients to enter hospitals to observe how data and diagnoses were formed.
    • The idea is that labels and information shape decisions and interpretations in clinical settings.
    • The transcript notes certain details (e.g., “you can’t talk to Czech” and “advocate for citizenship”) that indicate ethical and interpretive complexities in the study; the precise wording is unclear in the transcript, but the broader point is about the influence of labels and context on clinical judgment.

The Rosenhan Experiment (1973): Implications and Ethics

  • Core idea: pseudo-patients were admitted to psychiatric hospitals; staff relied on psychiatric labels to interpret behaviors.
  • Key implications:
    • Questioning the reliability and validity of psychiatric diagnoses.
    • Demonstrating how labels can distort interpretation of normal behavior as pathological.
  • Ethical considerations:
    • The use of deception in research and potential harm to patients and hospital operations.
    • Debates about consent and the balance between scientific knowledge and ethics.
  • The slide notes a point about Spitzer (a key figure in DSM criteria development) and clinical significance, though the sentence is incomplete in the transcript.

Clinically Significant Threshold and Diagnostic Criteria

  • Clinically significant vs mere symptom presence:
    • For a condition to be considered a disorder, it must reach a threshold of clinical significance (impairment/dysfunction beyond mere symptoms).
  • Role of diagnostic criteria:
    • Researchers like Spitzer contributed to defining criteria; thresholds and criteria can be contested and refined over time.
  • Tension in diagnosis:
    • The discussion suggests a tension between symptom presence, impairment, and the evolving nature of diagnostic thresholds.

Burnout, Work Conditions, and Explanatory Approaches

  • Burnout as a target for illness models:
    • Explaining burnout through internal processes (e.g., resilience deficits) rather than solely social determinants.
  • Integrating multiple factors:
    • Consider both internal resilience and external factors (workload, organizational support) when assessing burnout.
  • Caution against over-personalizing:
    • Avoid attributing all distress to individual pathology without considering environmental contributors.

Ethical, Practical, and Philosophical Implications

  • Medicalization of distress:
    • Benefits: potential for treatment, legitimacy, and access to care.
    • Risks: stigma, over-medicalization of social or contextual problems, labeling individuals as inherently diseased.
  • Diagnostic systems and change:
    • How criteria influence clinical practice, treatment decisions, and patient experiences.
  • Balance between biology and environment:
    • Recognize possible biological components while maintaining awareness of social, cultural, and environmental contexts.
  • Educational and research implications:
    • Use of classic studies (e.g., Rosenhan) to critique current diagnostic practices and to improve clinical approaches.

Connections to Foundations and Real-World Relevance

  • Foundational principles:
    • Bio-psycho-social model: an integrated view of biological, psychological, and social factors.
    • Importance of evidence, replication, and critical appraisal of diagnostic categories.
  • Real-world relevance:
    • How clinicians interpret symptoms and assign diagnoses affects treatment planning.
    • Implications for workplace mental health strategies, burnout interventions, and healthcare policy.
  • Ethical and practical implications:
    • In research and clinical practice, decisions about labeling, treatment, and patient care require careful consideration of potential harms and benefits.

Quick Takeaways and Reflection Prompts

  • Integrate evidence across courses and readings; connect ideas to real cases (burnout, illness labels, treatments).
  • Consider the ethical dimensions of research (e.g., deception in Rosenhan) and the social impact of diagnostic labels.
  • Reflect on how biological explanations interact with social and environmental factors in understanding mental health.
  • Prompt questions for exam preparation:
    • How would you apply these concepts to a case of burnout or burnout-like symptoms?
    • What biases might influence diagnostic labeling and interpretation?
    • How do biological explanations complement or challenge social and environmental perspectives in your interpretation?