Lecture 1

Question 1

Statistical rarity

Answer 1

Uncommon, unusual

Are MHP rare?

Question 2

Deviance from norm

Answer 2

Quite a judgement call

Question 3

Distress

Answer 3

E.g. a person with anxiety may be very unhappy.

But some people with MHP do not experience distress.

Question 4

Dysfunction

Answer 4

E.g. having depression may make it hard to hold down a job.

But functionality is defined by social norms.

Question 5

MHP

Answer 5

A significant source of distress to individuals and families.
A considerable burden on health resources of societies.
WHO says 1 in 4 people will experience a MHP during course of their lives.

Question 6

Diagnosing MHP

Answer 6

Diagnostic and Statistical Manual of Mental Disorders DSM-5 (American Psychiatric Association 2013)

Question 7

What is a ‘mental disorder’?

Answer 7

According to DSM-5:

• A syndrome
• Characterised by clinically significant disturbance in an individual’s cognition, emotion regulation or behaviour
• Reflects a dysfunction in the psychological, biological or developmental processes underlying mental functioning
• Associated with significant distress or disability
• Excludes culturally approved responses and socially deviant behaviour

Question 8

Advantages of mental health diagnosis

Answer 8

• Assists communication about research + treatment
• Brings relief through appearance of an explanation and awarenes that others have the same problem
• Assists managers/policy makers decide which problems are serious enough to deserve treatment or funding

Question 9

Disadvantages of mental health diagnosis

Answer 9

• Locates problem within individual
• Suggests an illness, ignores social causes
• Decreases hope of recovery
• Stigma from labeling
• Categories vs. dimensions (not normal/abnormal but extensions of normal behaviour/problems)
• Poor reliability - experts can’t agree about who has got what
• Poor validity - diagnoses don’t look the same or predict behaviour, future or response to treatment
• Co-morbidity

Question 10

Models which explain MHP

Answer 10

• Historically - people have always tried to explain abnormal/deviant behaviour
• All explanations represent a particular ‘worldview’
• Explanations for deviant behaviour results in different treatment approaches

Question 11

Historical explanations

Answer 11

• Early middle ages: Demon possession - exorcism
• Late middle age: witchcraft - ducking
• The ‘Enlightenment’ 17th-18thC : Categorisation and confinement - the search for ‘illness’ e.g. blood letting
• 18-19thC - Pinel & Tuke ‘moral treatment’ e.g. eradicating promiscuity (women)
  = more humane

Question 12

Current explanations and approaches to MHP (medical model)

Answer 12

• Uses metaphors of physical illness to describe MHPs
• Genetic and neurological explanations
• Tends to ignore psychological and social explanations, yet strong evidence for this
• Tends to propose medication as a primary solution

Question 13

Criticisms of medical model in MH

Answer 13

• Over-simplistic representation of genetic causality
• ‘No patient has ever benefitted from genetic research into mental illness’
• Weak evidence for relationship between ‘chemical imbalance’ and MHPs
• Even where neurological differences have been found - brain differences can be caused by env so it is not clear that neurological characteristics is ‘cause’ of problem

Question 14

Advantages of medical model

Answer 14

• If it works, it works fast (medication)
• Avoids dealing with causes
• Cheaper?

Question 15

Disadvantages of medical model

Answer 15

• Suggests problems are an illness
• Ignores psych-social causes
• Doesn’t help people to help themselves
• Adverse effects

Question 16

Psychologist approach: The bio-psycho-social model

Answer 16

• Psychologists generally believe that MHP are causes by an interaction of biological vulnerability and psychsocial stress
• Challenges what has been called the bio-bio-bio model
• Read & Saunders (2010) argue that more weight needs to be given to env conditions that cause MHPs than to biology