Chapter 1 (Lecture)

Question 1

How do professionals interpret and respond to mental health symptoms?

Answer 1

1. a person has a disease with a biological cause
2. a person has a disorder - a dysfunction that is mental in nature, whatever the cause
3. the symptoms and behaviours are within the spectrum of normal human responses to stressors

Question 2

Definitions of mental health

Answer 2

1. mental health is the freedom from suffering, abnormal behaviour, and distress
2. mental health is the absence of mental illness

Question 3

What is distress?

Answer 3

• mental - refers to feelings, awareness, cognition, behaviour
• health.- is associated with feeling good, while “illness” is associated with feeling bad (however, bad feelings are a normal part of human experience so does having these make a person ill?)

Question 4

What is abnormality?

Answer 4

Another way to think of mental health and illness is to consider the constructs of NORMAL and ABNORMAL

We usually assume that abnormal = unhealthy

Question 5

What is dysfunction?

Answer 5

If a persons mental status makes it difficult for them to meet their daily needs and fulfil typical responsibilities, this could be considered dysfunctional

However, individuals capacity is influenced by a persons resources and environment (this is where the social determinants of health start to enter the equation)

Question 6

WHO definition of mental health

Answer 6

A state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community

• important to note that some people have less ability to contribute to society due to sexism and racism

Question 7

DSM definition of a mental disorder

Answer 7

• psychological, emotional, behavioural disturbance
• impairs normal functioning
• allows for negative reactions to stressors and events
• context-specific and a little non-committal

Question 8

Models of mental health and illness

Answer 8

• biomedical
• psychological-behavioural
• social

most practitioners use more than one model
each prioritises particular causes and solutions for problems

etiology: the cause, or set of causes, for a particular medical condition or disease

Question 9

Biomedical model

Answer 9

• assumes that there is a binary division - a person is either mentally ill OR mentally healthy
• sees good mental health as the natural human state
• suggest that mental illnesses have specific causes, such as a dysfunction of the brain or neurotransmitters (chemical imbalance)
• mental disorders as a form of “brain disease”, each is a distinct disease with specific causes, which produces dysfunction and the diagnostic symptoms
• causes may be genetic or acquired (through exposure, infection, injury)

Question 10

Biomedical Model Interventions

Answer 10

brain based interventions are considered the best way to treat mental illness
- psychopharmaceuticals (medications)
- electroconvulsive therapy (ECT) (ECT applies electrical current to the brain to induce a seizure to provide relief for individuals with refractory mood)
- genetic interventions (potentially in the future)

Question 11

Psychological-behavioural Model

Answer 11

• considers mental disorders to be patterns of thinking, feeling, and behaving that are harmful to individuals
• does NOT assume a binary between mental health and mental illness (more of a spectrum)
• assumes that symptoms (sadness, fear) exist along a continuum, disorders are defined on severity of these symptoms and an accompanying pattern of additional symptoms
• largely individually-focused still
• causes focus on personal experiences (especially early life), experiences, events, producing patterns of thoughts and feelings (mistreatment can lead to distrust and fear)

Question 12

Psychological-Behavioural Model Schools Practice

Answer 12

• Freudian psychoanalysis
• psychodynamic approaches
• behaviours
• humanism

All of these support the idea that mental illness arises as a result of our personal experiences and perspectives, with a focus on the mind, thoughts and behaviours

Question 13

Psychological-Behavioural Model Interventions

Answer 13

Treatment within this model relies on psychotherapy - talking and thinking in a collaborative relationship with a practitioner

Types of psychotherapy:
- cognitive behaviour therapy (CBT) (aims to analyse and restructure thoughts and behaviours to help individuals address these two components of mood/mental wellbeing)
- psychodynamic treatment
- humanistic therapies
- existential approaches to therapy

psychotherapy (a method of treating mental disorders, but the practice generally involves talking to a trained professional about thoughts, feelings and behaviours)

Question 14

Social Model

Answer 14

• sees mental health as a social product, problems are social in nature
• this means that good or bad mental health are socially constructed and produced - defined by social relations and norms
• this model places less emphasis on individual characteristics and qualities, and considers the individual in the context of their social environment
• disorders are not concrete diseases, but “constructed” and redefined in relation to what is “normal” behaviour
• strong critical component: “ill” is a label that shaped by power and culture and conferred upon people and behaviours that are disapproved

Question 15

Social Model Continued

Answer 15

• suggests that power and culture lead to the labelling of some people, often those who are marginalised, as mentally ill
• social interventions are suggested as a response to mental illness - things like supported housing and employment, as well as larger changes to reduce marginalisation
• demedicalization is also suggested - declassifying a mental illness and looking at social causes rather than individual causes of mental distress
• in this view the “epidemic of mental illness” is actually a symptom of social problems like racism, sexism, inequalities, isolation, etc

Question 16

what is demedicalizaiton?

Answer 16

process by which issues that are understood as medical problems are redefined and understood through other perspectives.

Homosexuality was once considered a mental illness/medical problems but now is understood as part of the normal range of human sexual behaviours

Question 17

Biopsychosocial Model (biological, psychological, and social)

Answer 17

• suggests that biological factors, social conditions, and individual experiences all contribute to a persons mental health
• social in this context refers to social determinants of health (income, housing, education, etc)
• tries to consider all of these factors in responding to mental illness in an individual, problems are not just psychological but rooted in social environment

Question 18

What are biomarkers?

Answer 18

measurable medical signs that objectively and consistently indicate the presence of a phenomenon such as a disease or infection

Question 19

Measuring or assessing a persons mental health

Answer 19

• very complex
• cannot be measured objectively only subjective assessment
• no biomarkers exist: blood tests and scans may be used in diagnostic work but mostly to rule out other conditions
• no test to prove someone is in good mental health

Question 20

Diagnostic Tools

Answer 20

• diagnostic and statistical manual generated by the American Psychological Association (APA)
• WHOS international classification of diseases (ICD) –> these guide physicians as they categorise and diagnose mental illness

Question 21

Diagnostic and Statistical Manual (DSM)

Answer 21

• descriptions of each diagnosis (or disorder), and includes a checklist of symptoms (thoughts, moods, behaviours) associated with each
• a practitioner observes and speaks with patients to make a diagnosis

Question 22

International Classification of Diseases (ICD)

Answer 22

• used for diagnosis, but also by researchers, governments, and health insurance companies
• definitive classification schemes are highly relevant to public health - we use them to track illness and treatment in health administrative data
• key role in defining what counts as a mental illness, who is deemed “sick” or unwell, and whether the costs of their treatment is covered

Question 23

Clinical Scales

Answer 23

Another important diagnostic tool
- measure patients mental states with a series of “standard” questions
- answers can be used to determine severity of the condition
- “score” for every item or question is calculated, the total indicates whether the person qualifies for the diagnosis and how severe their condition may be

Question 24

Hamilton Rating Scale for Depression

Answer 24

• written in the late 1950s by Max Hamilton, a psychiatrist at Leeds University and originally designed to evaluate the performance of the first group of antidepressant medications
• scale is widely available in two common versions (either 17 or 21 items, scored between 0 and 4 points)
• scale/criteria allow for presence of some depressive symptoms as “normal”
• mild/moderate/severe categorisation or “severity” levels (more symptoms, more serious)

Question 25

Potential for Bias in Diagnosis (1/2)

Answer 25

- clinicians may display biases related to patient characteristics: race, class, gender, weight - clinician characteristics may be influential too: training, race, gender, may influence diagnoses - potential for bias in diagnostic criteria too: symptom lists and criteria may make some individuals more likely to be diagnosed with particular conditions - boys and men: more likely to be deemed to have oppositional defiant disorder and conduct disorder - DSM based on Euro-American behaviour norms, may lead to over-, under-, or misdiagnosis of individuals from other backgrounds (partially due to cultural reasons)

Question 26

Potential for Bias in Diagnosis (2/2)

Answer 26

- classification and diagnostic systems are human made: "produced", "constructed" not purely objective and scientific - while based upon research and expert knowledge, they are developed through a committee process featuring social interactions and different personalities - committees are somewhat homogenous groups (lacking diversity)- upper middle class, largely white cultural background, in western societies - this may lead to diagnostic criteria that function to reinforce cultural norms (ethnocentrism) - unrecognised or un-reported conflicts of interest may exist (e.g., funding from Pharma companies, personal agendas)

Question 27

Why mental health matters

Answer 27

social meanings and identity - part of identity - may see ourselves as resilient (or anxious, or having melancholy) - diagnosis - may lead to getting help or getting better, but may bring experiences of discrimination or stigma, or a sense of loss (or reduced potential) - mental health can influence our identity in complex ways symbolic component - using concepts to understand human behaviours and experience - EX: "not criminally responsible defence" (pleading insanity) - traits like shyness, narcissism, hyperactivity, and anxiousness have become medicalised and are now symptoms of mental disorders - in a process called pathologization - "evil" and anti-social behaviour may stem from a mental disorder (like a personality disorder), but others are more skeptical about this view

Question 28

The fields of psychology and psychiatry tend to imagine that most conditions are universal (likely biological), even if presentations of the conditions vary by culture Why is this the case?

Answer 28

- ethnocentrism: tendency to imagine one's own culture as "universal" and project it onto others - assumes that Western concepts are universally applicable (and "best") - psychological norms and patterns of distress described in the DSM are largely based on white middle class patients - Western perspectives become the "default", the "normal", and the "universal"

Question 29

The fields of psychology and psychiatry tend to imagine that most conditions are universal (likely biological), even if presentations of the conditions vary by culture Critiques?

Answer 29

- little evidence that conditions are universal (no clear biomarkers, criteria are constantly changed and reformulated) - diagnoses are highly subjective (even clinicians sometimes cannot agree about particular disorder and patients) and culture-dependent, context-specific - may result in "othered" individuals experiencing greater levels of diagnosis and higher prevalence, and mistreatment/misdiagnosis - psychiatry should do more to recognise that expressions of psychological distress are culture-dependent

Question 30

DSM is very important, but what other alternatives have been proposed?

Answer 30

- Research Domain Criteria (RDoC), US National Institute of Mental Health - Goal: classification system that is more valid (objective) than the DSM - based on biomarkers (measurable biological indicators) rather than symptomology - Radical!!: could overturn existing "facts" about disorders, and current descriptions/criteria, and perhaps the whole classification system

Question 31

Why does mental health matter? General

Answer 31

- influences how we experience he world and can shape our potential and activities - helps us understand and explain our actions and behaviours - social meaning - good mental health = easier to cope and navigate challenges - poor mental health = things are more difficult (more distress, discomfort) - goal of public health in relation to mental health = decrease suffering through medical (or social) means

Question 32

what is social determinants of health?

Answer 32

external factors that can influence a persons health. Like a persons income, gender, social networks, levels of education, and the political system in which they live in

Question 33

Popular strategies for improving mental health (7)

Answer 33

1. ignore the social media doomsayers 2. breathe better 3. bolster your microbiome 4. lower your anxiety with yoga 5. get out in the garden 6. eat more healthy foods 7. reduce your ultra-processed food intake ALSO: connect with other people, move your body (exercise), and embrace the outdoors

Question 34

Key Prevalence stats from textbook

Answer 34

- WHO estimates 322 million people are living with depression, nearly 5% of the global population - 264 million described as having an anxiety disorder, a prevalence of 3.49%, and specific regions like North America are estimated to have even higher prevalence - roughly 1 in 3 people are diagnosed with a mental health problem at some point in their lifetime (lifetime prevalence measure)

Question 35

Actors in the Mental Health Care System

Answer 35

- psychiatrists (Physician, provide diagnosis, prescribe medication, can provide psychotherapy, can order someone to involuntary psychiatric treatment) - psychologists (diagnosis, can provide psychotherapy) - social workers - registered psychiatric nurses - counsellors, therapists, psychotherapists - life coaches - religious advisors - also "peers" or PWLE of mental illness