Week 1

Question 1

What is concept creep?

Answer 1

Some concepts of mental health and illness have become
over-extended through a process known as ‘concept
creep’. Whereas concepts such as ‘depression’, ‘anxiety’
and ‘trauma’ once referred primarily to conditions or
events that were relatively extreme and disabling, they are
increasingly used by members of the public and the
mental health professions to refer to less severe phenomena.

Question 2

What are umbrella concepts?

Answer 2

Specific terms commonly replaced in disocurce with ‘mental health’, ‘mental illness’ and ‘distress’

Question 3

What is the shift to the benign?

Answer 3

Marginalising those with more serious conditions

Question 4

WHO definition of mental health

Answer 4

“Mental health is a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community.”

Question 5

How does Wakefield’s Harmful Dysfunction Analysis (HDA) define mental disorders?

Answer 5

Dysfunction – a failure of an internal neurobiological or mental mechanism to perform its natural (evolved) function.

Harm – this dysfunction results in harm judged by societal standards.

Question 6

What is a mental disorder?

Answer 6

“A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning.”

Question 7

What is not a mental disorder?

Answer 7

“An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder.”

Question 8

What are the three primary approaches to classification models of mental disorder

Answer 8

Categorical: divides psychological disorders into categories based on criteria sets with defining features.

Dimensional: degrees of psychopathological phenomena occur along continuums.

Alternative models that do not focus on the mental health and illness concept

Question 9

What are the advantages of categorical vs dimensional classification?

Answer 9

Categorical

• Better clinical and administrative utility – clinicians are often required to make dichotomous decisions.
• Easier communication

Dimensional

• Closely model lack of sharp boundaries between disorders, between disorders and normality
• Have greater capacity to detect change, facilitate monitoring
• Can develop treatment-relevant symptom targets – not simply aiming at resolution of disorder (most treatments actually target symptoms, not disorders).

Question 10

What classification system does the DSM - 5 use?

Answer 10

Mainly categorical but some dimensional aspects too (+ diagnostic groupings)

Question 11

What are DSM - 5 diagnoses based on?

Answer 11

Clinical Interviews – clinician and client semi-/structured

• Text descriptions – in DSM covering how disorders present
• Diagnostic criteria – does presentation match checklist?

Currently presenting symptoms and severity – e.g. depressed mood

Rule out disorder due to general medical condition – e.g. due to hypothyroidism

Rule out disorder due to direct effects of a substance – e.g. alcohol induce

Question 12

What is the DSM - 5 diagnostic approach?

How do you give someone a diagnosis?

Answer 12

Establish boundary with no mental disorder

• Clinical Significance/Cultural Norms. E.g bereavement vs clinically significant depression

Determine specific primary disorder(s)

• Multiple diagnoses possible

Add subtypes/specifiers

• severity (mild, moderate, severe – with or without psychotic features)
• treatment relevant (poor insight, atypical, etc.)
• longitudinal course (with/without full inter-episode recovery, seasonal pattern)

Question 13

What is a semi-structured DSM - 5 assesment tool?

Answer 13

Mental state exam (MSE)

Question 14

What is a structured DSM - 5 assesment tool?

Answer 14

A structured clinical interview (SCID-5-TR)

Question 15

What does anhedonia mean?

Answer 15

Losing interest in all/most activities

Question 16

Example of how case formulation may be carried out

Answer 16

Biopsychosocial evaluation

Question 17

What is the biopsychosocial paradigm?

Answer 17

dominant model in modern clinical psychology and psychiatry (see image for more details)

Question 18

What are some models of psychopathology?

Three main models

Answer 18

Psychoanalytic
Behavioural
Cognitive

Question 19

What is the psychoanalytic paradigm?

Freud

Answer 19

Freud believe the unconscious has a profound influence on what we do and how we feel in day-to-day life.

• Psychopathology caused by unresolved childhood conflicts and repressed desires (creates psychic tension)
• Only through gaining awareness of unconscious processes can individuals resolve and recover.

Question 20

What is the psychoanalytic perspective?

Answer 20

J.B. Watson

B.F. Skinner

Goals of behavioral interventions include:

• interrupt and/or change maladaptive stimulus-response associations;
• reinforce adaptive behaviour (avoid things that make us anxious)

Question 21

What is the cognitive paradigm?

Answer 21

Beck
What we think affects how we act/feel
What we feel affects what we think and do
What we do affects how we think and feel

Question 22

What are First Nations Models of social and emotional wellbeing?

Answer 22

Culture can influence Aboriginal and Torres Strait Islander people’s decisions about when and why they should seek health services, their acceptance of treatment, the likelihood of adherence to treatment and follow up, and the likely success of prevention and health promotion strategies…

Question 23

What is the anti-psychiatry perspective?

Answer 23

Psychiatrists including:

• Thomas Szasz: mental illness is a myth (e.g. no disease identified)
• J.D. Laing: psychiatry inappropriately pathologizes human distress (e.g. schizophrenia symptoms are a normal response to adversity).

Social theorists like Michel Foucault and Erving Goffman argued:

• psychiatry enforces societal norms.
• serves to marginalise and stigmatise those with psychological problems.
• is coercive, pseudoscientific, and socially constructed.
• causes harm.

Question 24

What is the Mad Pride perspective?

Answer 24

A social and political movement.

Grounded in protest and challenge of stigma, discrimination, and historical psychiatric practices that infringe on human rights.

Pride in the self as a complex whole that incorporates madness into identity.

Reclamation of pejorative terminology. Parallels with LGBTIQA+ Pride movement.

Question 25

Describe origins of stigma

Answer 25

*‘Stigma’* originated with the ancient Greeks, who physically branded criminals, slaves or traitors in order that they may be identified as undesirable and avoided (Goffman, 1963). People who were considered to be fundamentally flawed and to be avoided - the mark was a warning Can go back to ancient Mesopotamia, but even animals do it (primates etc) Stigmatising originally helped identify difference = threats = could keep you alive, but in modern society it has become maladaptive because the things we stigmatise don’t generally pose a threat to us

Question 26

Describe Fox (2017) Mental Illness Stigma Framework | what are the two groups of people involved in process of stigma?

Answer 26

2 main areas: people being stigmatised (in this case, people living with mental illness) and people who are doing the stigmatising.

Question 27

Describe the Lancet Comission

Answer 27

Umbrella review: biggest one done Self stigma = internalising stigma and turning them into the self Stigma by association = experienced by family, friends, supporters, etc Public Stigma = driving force for stigma existing in society (focus for lab report) Structural discrimination = how laws, practices, ideologies limit opportunities for people with lived experience and discriminate against them

Question 28

Describe the perspective of the Stigmatiser | 3 things

Answer 28

**Perspective of the Stigmatiser** **Public Stigma** (plural of *personal stigma*) refers to stigma exhibited by the public towards those with a mental disorder. Public Stigma: * Manifests in three ways: 1. *Stereotyped attitudes* and *beliefs*. e.g. someone is ‘less than’ – manifest through devaluing language. 2. *Prejudicial affective responses*. e.g. fear. 3. *Discriminatory behaviours*. e.g. avoidance of interaction or social exclusion. - Is thought to be particularly harmful, and the driving force behind other aspects of stigma. Note: big problem to address in lab reports is the stigma that people with psychosis are danger Reduce societal stigma = reduce self stigma

Question 29

Describe Pat Corrigan's social cognitive model for Stigmatiser perspective

Answer 29

Signal = point of difference Responsible = “I was depressed once but I got on with it and you should too” Controllability = big factor in stigma and stigma intervention Use internet image

Question 30

Describe Corrigan's Self Stigma of Mental Illness

Answer 30

Self-stigma of Mental Illness (Corrigan, 2002, 2006, 2012). Awareness: "I am aware of the stereotype that people with schizophrenia are dangerous." Agreement: "I agree! People with schizophrenia are dangerous!" Application to the self: "I have schizophrenia. Therefore, I am likely to be dangerous." Damage to self: self-esteem, self-efficacy, mental health problems exacerbated etc. Corrigan’s Paradox: stigma may damage or energize. People may: experience damaged self-esteem; 2) react with protest and righteous anger; 3) seem indifferent. Explained by awareness, agreement (context is important), and group affiliation (identity)

Question 31

Describe National Survey of Mental Health Related Stigma and Discrimination

Answer 31

Stigma in Australia: Up: Stigma about lower prevalence and poorly understood disorders like schizophrenia. Down: Stigma about high prevalence disorders like depression and anxiety. 2022: V. Large national study of 8000 Australians - National Survey of Mental Health Related Stigma and Discrimination People randomly allocated to read a series of vignettes about different disorders and to respond about the person in those disorders. A way to operationalise the disorder you theorise is stigmatised and allows very precise controls about which things elicit responses and which don’t. Response was to signs and symptoms not a diagnostic label.

Question 32

Describe results of National Survey of Mental Health Related Stigma and Discrimination

Answer 32

Schizophrenia, BPD, early schizophrenia = most stigmatised Depression, ED, Social phobia = least stigmatised generally and in social discrimination

Question 33

Describe National Stigma Report Card

Answer 33

**Aims:** 1. **understand** how Australians living with severe and complex mental illnesses experience stigma and discrimination; 2. **advocate** for action to address findings Around 2000 people **Who participated?** Participants were Australian residents, aged 18 and over, and living with at least one of the following severe and complex mental health issues over the 12 months prior to taking part: - **Schizophrenia spectrum disorders** - **Bipolar and related disorders** - **Personality disorders** - **Obsessive-compulsive and related disorders** - **Post-traumatic stress disorder** - **Dissociative disorders** - **Eating disorders** - **Severe and treatment-resistant depression or anxiety requiring multi-agency support**

Question 34

Describe results of National Stigma Report Card | What are the three types of behaviour of people who are stigmatised?

Answer 34

Perception, Anticipation and Withdrawl all consistent with stigmatisation of these groups of people (was also some positive treatment too)