Mental Disorders

Question 1

What is a mental disorder?

Answer 1

Alterations in thinking (cognition), mood, or behavior associated with significant distress and impaired functioning (impaired functioning = interfere with daily activities, relationships)

Question 2

What constitutes significant distress (to qualify as a mental disorder)?

Answer 2

Normal to experience sadness, especially after difficult life event.
Significant =
- duration: depressive feelings last abnormally long time after stressful event, dependent on situation
- quality: intensity of feelings (ex: suicidal thoughts vs just feeling a little down)

Question 3

What is psychosis? What are the symptoms?

Answer 3

A “loss of touch with reality”

• hallucinations = see/hear things that aren’t actually there (sensory)
• delusions = false beliefs, paranoia, not based in reality (persecutory and of grandeur)
• disordered thinking = thinking that doesn’t make sense, irrational, illogical, not linear

Question 4

Two types of delusions and examples?

Answer 4

1) Persecutory delusions = someone is following me/trying to control me/watching me (government put a chip in my brain, cops are looking in my windows)
2) Delusions of grandeur = believe they are a certain person (I am Jesus reborn, I’m married to Ryan Reynolds)

Question 5

What are most common mental disorders in Canada?

Answer 5

#1 = mood and anxiety disorders (11.7%)
#2 = substance abuse (5.9%)
#3 = cognitive impairment/dementia (2.2%)

Question 6

What are the 4 main causes (etiology) of mental disorders?

Answer 6

• genetic factors
• biological factors
• psychological factors
• social factors

Question 7

What is the etiology of psychosis/schizophrenia?

Answer 7

1 = genetics (50% of the risk is from genetics)

• maternal nutrition
• viral infection (mom sick during preg/kid born in virus seasons)
• perinatal complications (issues during birthing)
• exposure to toxins, chemicals, loud/dirty environments (either when mom preg or when younh kid)
• social stress (death of child/close relation, demanding job, immigrants and children of immigrants)

Question 8

What is the etiology of affective disorders? (mood etc)

Answer 8

• genetics (complicated mess of genetic markers, less telling than for schizophrenia)
• other medical conditions (high rate of concurrence between mood disorders and lots of other health issues)
• gender: women more likely than men (hormones crazy change at certain life phases)
• age (adolescence and elderly)
• abuse
• loss/rejection/isolation
• general stress
• substance abuse (sometimes disorder caused by it, sometimes disorder causes it)

Question 9

What did Leonard Pearlin and colleagues do in relation to stress and mental illness?

Answer 9

They studied depression rates in people recently unemployed, compared differences between the people who were and werent depressed

Question 10

What did Leonard Pearlin and colleagues conclude with their research?

Answer 10

People who did develop depression after unemployment…

• had lower self esteem
• placed higher value on financial success (vs having other things be more important)
• reported low levels of emotional support (no family, lost only friends with work)
• high levels of external locus of control (factors outside of selves control their lives / internal = I’m in control, I can change this)

Question 11

What did Alexander Leighton do in relation to stress and mental illness?

Answer 11

Studied role of environment/social ecology in the etiology of mental illness. Hypothesized that communities with ‘high disintegration’ were more likely to have higher mental illness rates.

Question 12

What is a disintegrated community according to Alexander Leighton?

Answer 12

(Similar to Durkheim anomie stuff..)

• recent history of disaster (community members died, weather disaster, etc)
• excessive poverty (overall low socioeconomic status)
• cultural confusion (conflicting cultural groups - racial, ethnic, religious)
• rapid social change (ex: lottsss ppl left/arrived to community in a short period)

Question 13

What did Alexander Leighton say about individual stress?

Answer 13

There is a common core/’bundle’ of main strivings/needs (similar to Maslow Hierarchy)

• physical security
• sexual satisfaction
• love
• security
• individual recognition
• sense of belonging to group
• orientation toward oneself and ones place in society/social group
• spontaneity/creativity
• belonging to moral order
• feeling of being ‘right in what one does’

Question 14

What was the historical biological treatment (psychiatry) for mental illnesses?

Answer 14

• blood-letting (flush out them toxins)
• lobotomies (take out that piece of brain causing psychotic symptoms)
• insulin therapy (shock the body)
• electro-convulsive therapy (shock the body)
  Now we use medications intended to alter neurotransmitters

Question 15

What was the historical psychological (psychology) treatment for mental illnesses?

Answer 15

• thereapeutic communities (remove person from toxic environment/community and get em into a healthy one with group meals and activities but still independance)
• catharsis = psychoanalytic theory (Freud: people ill because of repressed emotions, so need talk to someone and get it all out (release!), sometimes use hypnosis)

Question 16

Who explained the growth of the asylum and why did it happen?

Answer 16

Edward Shorter 1997

• More illness was showing up with neurosyphilis creating psychological conditions
• less available places (b/c workhouses closed and jails full)
• less people tolerant of family members with psychotic illnesses
• increased legitimacy of medicine/psychiatry
• asylum seen as more humane environment

Question 17

Why did deinstitutionalization happen?

Answer 17

• laws were being questioned by the hippiieessss
• people who refused to go to war had to work in asylums instead and began to expose them to the media
• promise of community mental health services
• political economic influences (medicare stuff) so mentally ill person was $$$ to gov

Question 18

What were the results of deinstitutionalization?

Answer 18

• poverty (inadequate financial support even with medicare –> mentally ill people often homeless)
• homelessness
• suicide
• imprisonment (b/c people called the cops on mentally ill people when they were having trouble)
• substance abuse
• violence (mainly against mentally ill, but sometimes they were instigators)
• family stress (family forced to care for person without money or training)
• victimization

Question 19

What did Fuller Torrey say in 2001 about deinstitutionalization?

Answer 19

It represented the launching of a psychiatric titanic, and was the largest failed social experiment of the 20th century

Question 20

What are the costs of mental illness to the individual?

Answer 20

There was the disease paradigm (emphasis on biological effects) and discrimination paradigm (emphasis on social effects)

Question 21

What was the disease paradigm? (related to cost of mental illness to the individual)

Answer 21

Direct impact on the individual – the symptoms and managing them on biological scale (medications, side effects, ineffective meds)
This also relate to psychopharmaceutical revolution (50s/60s) when drugs to solve these problems showed up and everyone was amazed

Question 22

What is the discrimination paradigm? (related to cost of mental illness to the individual)

Answer 22

Emphasis on role that stigmatization plays in the daily experiences of people with mental illness (social, the social reality they live with)
Stigmatization = attribute that is deeply discrediting, characterizes person as tainted, etc. - Erving Goffman
–> gives master status (mental illness is only identifying factor fot that person)

Question 23

What are the common misconceptions people have about schizophrenia (the stigmas!)? What is the actual truth?

Answer 23

1. uncertainty = uneducated about the illness so assume schizo people are always psychotic (they’re actually not, only rarely/a few times)
2. Unpredictability = assume schizo people will act out randomly/are unstable/suddenly change moods (probably because people mix up with dissociative identity disorder, which has no relation!)
3. Incompetence = assume schizo people are unintelligent (it affects people no matter what their IQ etc is)
4. Dangerousness = believe they’re more violent, probably due to media always mentioning a criminal’s mental health status dammit (obviously not true, they more danger to selves)
5. Responsibilization = treatment available so assume schizophrenia should not be happening at all anymore, blame the person for not ‘getting help’ (very difficult to find fitting treatment, meds have horrid side effects)

Question 24

How is stigma different between cultures?

Answer 24

Hooley 1998: Euroamericans have high internal locus of control so much more blame/stigma is placed on the person for not having their illness sorted out b/c they should be in control

Jenkins 1988: Latin americans use ‘nervios’ explanation - most stuff is due to nerves, which everyone has and has at some point had an issue with (headaches > stage fright > anxiety > schizophrenia) so much more normalized and less stigma // western society uses biochemical explanation and therefore more stigma because othering happens “I don’t have it but they do, insert insult”

Question 25

How is stigma around mental illnesses affected by the media?

Answer 25

- Mentioning criminals mental health status or that of people involved in any other news story - Publish stuff where people use incorrect/generalizing language ('I'll sweep psychos off the streets' campaign promise referring to criminals I guess and homeless people..?) - Fictional representations of mentally ill are ofc dramatized and often show them as violent/related to violence

Question 26

What is the problem when you look up schizophrenia?

Answer 26

Hard to find any actual peoples stories, most of information is from medical and psyhology professionals, no stories that prove you can be schizophrenic and have a successful good life

Question 27

What are the four management techniques for living with mental illness stigma?

Answer 27

1) Trying to pass = hide it, make sure no one knows (very tough requires constant monitoring, have to lie lots) 2) Dividing their social worlds = only tell certain groups/people, the ones that will be supportive, avoid telling those who may be stigmatizing 3) Deflecting = distancing self from the label or refuse it altogether "im not like them" 4) Challenging = confront stigmatization and those who perpetuate it, being assertive (hard to do, potentially opens self up for victimization)

Question 28

What are the three levels at which mental illness is a cost to society?

Answer 28

i) Individual level ii) family level iii) societal level

Question 29

What are the individual level costs to society?

Answer 29

Disability: government disability pension costly, employer costs as well esp bc mentally ill people miss more work Suicide: approx 4000 Canadians die per year, rate is very high for indigenous communities, especially young men Treatment: cost taken on a lot by government and society (taxes), 70% government and 15% private insurance/employers, but 80% of psychological treatment is not covered Victimization: many mentally ill people end up homeless, often victimized (beat up, etc) especially during winter bc of the cold

Question 30

What are the family level costs to society?

Answer 30

Financial burden: other support for person often not enough, parents also often lose work hours to take care of mentally ill child Emotional burden: parents end up depressed etc from difficulties of taking care of mentally ill kid and the stigma that is applied to them as family members Caretaker burnout: forced to manage all types of stuff and mediate between doctors and family and work/school for person, extreme exhaustion with minimal/no support Stigmatization: courtesy stigma when family/friends experience stigma because associated with mentally ill person, deal with this publicly so end up withdraw from society a little, family members and friends also distance selves from family leaving caretaker and ill person much more alone

Question 31

What are the common family problems reported by families with a mentally ill member?

Answer 31

- worry and stress - interrupted sleep, disrupted household routine - embarrassed by family member's behaviour - family frictions --> avoidance, withdrawal - loss of social contacts - missed work

Question 32

What are the mental health services paid for by society? (societal level costs to society)

Answer 32

- case management - crisis lines - community mental health centers - psychiatric hospitals/ psychiatry beds - self -help groups - housing (not only solo but also some where w/ staff qualitied to help out w/ support, scheduling, money management) - vocational + employment supports - mobile crisis units, (go out + help during day bc mentally ill are often homeless) - social + recreational programs

Question 33

What are the costs to society from ineffectively treated mental illness? How do they arise?

Answer 33

When inadequate treatment, more/worse problems show up in the future --> emergency bed more expensive than general ward bed --> meds may not be perfect solution, may take time to find right one/combination, people may go off bc terrible Arise from: - lack of services - perception og treatment as inadequate (ex: med side effects, meds not chosen correctly) - discomfort with self disclosure so people dont get the help they need - neglect within families/communities (unable to support esp w/o medical knowledge) - fear of stigmatization

Question 34

What is the main way that mental disorders are socially controlled? How?

Answer 34

Medicalization! = process by which human conditions/problems come to be defined and treated as medical conditions (social construction) - Irving Zola in 1922 said medicine had superceded religion and law in the area of health and illness (doctors had more power to label someone as healthy/ill than priests and judges) - -- also said much of daily life was becoming medicalized - Others said the primary driver of medicalization is the medical profession and the related institutions

Question 35

What type of stuff is/has been on the list of medicalized disorders?

Answer 35

- alcoholism - homosexuality - masturbation - ADHD/hyperactivity - premenstrual syndrome - post-partum depression - hoarding

Question 36

What is the process of medicalization? Give examples for each step

Answer 36

1) behaviour previously seen as normal/deviant increasingly being seen as medical 2) Intra-debates (b/t medical professionals) - doctors argued that estrogen was cause of PMS, then maybe other hormonal factors 3) Inter-debates (b/t all health professionals) - psychology people argued PMS may be based on personality etc, sociologist blamed poverty/work environment/etc 4) Lay-debates (b/t general public and health people) - feminist arguments on what medicalization could do to custody battles and other womens issues 5) Institutionalization (condition now seen as legit category warranting medical intervention) - treatment researched, discuss PMS as medical condition

Question 37

What are the benefits of medicalization?

Answer 37

- reduces stigma of living with condition (less judgement/blame) - empathy for people with condition (also less judgement/blame) - ensure that the person with the condition is able to receive help (actual diagnosis help get meds etc)

Question 38

What are the potential problems associated with medicalization?

Answer 38

1) The medical profession may come to 'own' the condition (gets all the finding, pull people away from other areas of research bc that new condition has more money etc) 2) Tunnel vision so closes off discussions about social/psychological/etc effects (ex Lily Tomlin comedt sketch doctor immediately diagnose as PMS but really probably just compounding stress/etc from various life events/situations) 3) May be used to justify involuntary treatment (CTO + force someone to get treatment) or Responsibilization (can't work today because youre PMSing? well theres drugs to fix that, so you better get to your doctor and be into work by this afternoon)

Question 39

What is the link between involuntary treatment and the deinstitutionalization movement?

Answer 39

People were left to live in community, end up w/o housing/support/money/etc, end up deciding to go off meds b/c now living on own and feel they dont need them (the part of the brain that tells you hey youre hurt you need help is affected by schizophrenia, so they dont see themselves as sick). People need help but cant be forced in against will unless harm to self or others, but there's evidence that more psychotic breaks lead to further damage to the brain so you wanna limit that. So Community Treatment Orders were created.

Question 40

What is a community treatment order? (CTO)

Answer 40

Designed to address the revolving door patient (often those who are schizophrenic) - alternative to involuntary hospitalization - pairs medical and legal stuff bc get patient to agree to this contract ish that says they have to come in every 2 weeks or smthn to see nurse and if dont, only then will they be forced against will, but otherwise they're good to go and can do their thing - helps monitor patients (close tabs on em) and keep them at a good level rather than waiting until something drastic happens

Question 41

How is CTO policy an instrument of social control/what are people's concerns with CTOs?

Answer 41

- Its a lil coercive = often only let person leave hospital if they do sign this agreement so ofc theyre going to do it (breaches personal Charter rights) - Unsure if it is fully evidence based bc introduced before a lot of testing/research was done - Its pretty much reinstitutionalization = ties them back to an institution, often the agreement requires them to be in some sort of supportive housing which may not even be the right treatment they need

Question 42

What was the difference between the Looney Tuners and the Mixed Nutters?

Answer 42

- Mixed Nutters was higher percentage of men in group (looney tuners was almost 50/50) - MN were big 2.5 million city, LT were 300,000 smaller city - Both lived rooming houses boarding homes MN lived also cheap hotels, while LT lived in missions or just on streets - LT grade 8 ave education (MN = g7) and from middle class backgrounds as well (MN was just working class)

Question 43

From the reading, what was said about non-chronic vs chronic mental illness patients post-deinstitutionalization?

Answer 43

Non-chronic: - tried to return to normalcy - viewed new deviant identity as temporary - self perception influenced by label - employed 5 major offensive strategies to mitigate stigma: selective concealment, preventive telling, therapeutic telling, normalization, and political activism – all intended to have positive implications for identity - got positive support from friends and family upon discharge. Chronic: - didnt try for normal because internalized role of 'mental patient' - accepted permanent deviant identity, reinforced by labels - no support from family/friends/etc, only judgement - adopted defensive strategies to avoid stigma: "institutional retreatism", "societal retreatism", capitulation, and passing — all ending up having negative implications for identity.

Question 44

What has research into mental health shown about diagnostic biases?

Answer 44

- w/ same diagnostic instrument, black clients more likely to be diagnosed with schizophrenia + white clients more likely to be diagnosed with bipolar disorder - black = more likely to be criminalized rather than treated for symptoms/actions - women more likely to be prescribed meds for same symptoms Overall: marginalized groups are more likely to be misdiagnosed, especially if doctor isnt member of that group

Question 45

What are 5 deviant subcultures creates by Mixed Nutters and Looney Tuners?

Answer 45

1) Behavioural Patterns: hanging around (just doin things all together), shrink sessions (self help meetings where share feelings, all work together to combat stigma, see that not alone), schooling (teaching each other things abt how to make it on outside, like where get free food, busking/begging techniques) 2) Subcultural NOrms: what you should do! when hanging out, everyone pitches in cash, when doing illegal acts, only do it when absolutely necessary, and to the least extreme degree possible (prostitution, shoplifting, selling meds), and shrink sessions should be polite and quiet and confidential 3) Argot (lingo): show who in group and who not, talk nearly a different language so that eavesdroppers couldnt get shit out of htem 4) Boundaries: Each group had territory of a couple square miles, everything needed was in there so never left 5) Ideology: used to decide how to act, jsutify actions, how avoid 'normals'