Hlthage 1CC3 - 1cc3 notes

MENTAL HEALTH 1CC3 Monday September 9th Lecture 1: How do we Define Mental Health and Illness What are we describing? ● Abnormal feelings, thoughts, behaviour ● There’s a specific way people should operate and function, we have to bring them back to that normality ● People think mental illness is about suffering ● All suffering involves some kind of anguish; does that mean all suffering is mental illness? Does mourning count as mental illness? ● Mental illness; difficulty/problem in their daily function The Medical Model ● Arguably the most dominant in our society ● Model says mental illness are diseases, are physical illness ● Differs in how the symptoms are expressed ex: instead of sneezing, you may not be able to pay attention ● Also differs from how it is diagnosed ex; can't do an MRI to find a mental illness ● Biomarker is a term that is essentially a property of a disease ● We don't have a biomarker for mental illnesses ● The model is individually focused - looks for symptoms, series of events and treatments ● Talking about mental illness as disease, people have accused medicine of exaggerating some of the findings The Psychological Model ● Psychological mind is a kind of construct. It is not physical in nature ● Internal processes that reflect the interaction of the individual with their environment ● Often grounded in the past The Behavioural Model ● Psychologists prescribe to this model ● Learned behaviour ○ Need to teach people to unlearn what they learned ● Relies on the idea of conditioning ● Want to change the thought process The Social Model 1. Downloaded by Kevin Lang (dilas34153@fesgrid.com) lOMoARcPSD|31076631

Classification of Mental Disorders ● DSM ○ Guide to what is mental illness, every recognized diagnosis ○ Used by everyone ○ We identify alot for behaviour now than in the past ○ A big change is that we do not talk about cause and treatment anymore ○ This stuff has so much disagreement because depending on the persons model, they have a different idea ○ Like a cookbook that only has ingredients and a final product The DSM Definition of Mental Illness ● Clinically significant disorder ● Reflects a dysfunction in the psychological, biological, or developmental process ● Associated with significant distress or disability Criticisms of DSM ● Validity - the ability to demonstrate proof of existence ● We can’t verify mental illness the same way as physical ● There is no proof of actual mental illness ● Focuses on symptoms rather than experience ● The DSM is always changing with society ○ Ex: Homosexuality was in the DSM but removed after protests Difficulty with Diagnosis ● Co - morbidity ○ More than one illness ● Hirogenitity ○ A person must have a certain number of symptoms to be diagnosed ○ People with the same diagnosis may have different symptoms ● Race/gender/class biases ○ These characteristics can have an impact on people's diagnosis ○ Racism, classism, genderism is present ● Culture another important element ○ Different cultures may diagnosis differently ○ Ex: American vs. british ● Context also matters ○ Criminal or pyromania? ○ Same behaviours can be read differently based on whose diagnosing them ● Some diagnosis never make the DSM ○ Someone having abusive relationships An alternative definition of mental disorder ● Significant and voluntary deviations from the norm Downloaded by Kevin Lang (dilas34153@fesgrid.com) lOMoARcPSD|31076631

○ May experience loss of loved one, loss of job, etc ● Beck: Something like depression is about thought patterns Monday September 30th / thursday september 29 Anxiety Disorders Fear vs Anxiety ● Fear: body kicks in flight or fight response, understood as an irrational response to immediate threat or danger ● Anxiety: involves the same sensations as fear, but not about things in the moment, more about what may come to pass in the future ○ Not necessarily irrational or a mental illness ○ Something that all human beings have experienced ○ Profoundly physical in nature; increased heart rate, sweating, feeling on edge, difficulty breathing, etc. ○ Don’t feel controlled over their thoughts ○ Halo effect; surrounds the person and can colour their perception of things, more pessimistic towards the future ○ An emotion or experience in the same way happiness is ○ Can aid in things like focusing, avoid what future things you’re concerned about Classification of Anxiety Disorders ● Up until 1880, there was a general idea that mental health problems could be divided into psychosis and neurosis ○ Psychosis: involve ppl who are disconnected by reality in some way ○ Neurosis: had a concrete awareness, atypical or unrealistic in some way ○ Anxiety and depression were not separated ● Now there is a whole chapter of anxiety disorders in the DSM ○ Need to think about the impact on a person that gets diagnosed with 4-5 different disorders ○ Splitting movement has divided anxiety disorders, share core sympton- intense worry disproportionate to actual environmental danger ○ Many treat disorder and disease as one ■ If you feel like you have 5 diseases you’re gonna feel worse Downloaded by Kevin Lang (dilas34153@fesgrid.com) lOMoARcPSD|31076631

Social Anxiety Disorder - How does social phobia differ from specific phobia? - Focused on performance or interpersonal interactions - Can be about performance, social interaction - Not the action itself, - Originated in fear of being humiliated or embarrassed. If anxiety related to specific situation (eg. a speech), anxiety disappears if task performed privately - Introduced in DSM-III - 1980s: not frequently diagnosed mental health problem - Not many met the criteria to fit the disorder - Criteria expanded to be more inclusive with subsequent editions - Culture bound? - Start to look at what is going on in other parts of the world - Archetype of medicalization? - ● Can be anything from giving a speech to dating to being in a meeting at work ● Not the actual act itself that scares you, but the convects of the act itself; presence of other people who might humiliate you (practicing speech in front of mirror vs actually doing it in front of people) ● Criteria expanded to be more inclusive ● Very culture bound; maybe this is a product of north american culture Generalized Anxiety Disorder - “Chronic worries”, distress/impairment in occupational or social functioning - Not intense anxiety around something specific - Worry not fixed, may not even have clear source - Accompanied by minor disturbances in sleep, irritability, concentration, restlessness - Key issues: - Lower diagnostic reliability - Describing if multiple clinicians were to see the same person, would they come up with the same diagnosis? How reliable is this? - Far more common in women (roles? stereotypes?) - There’s lots of overlap with depression, clinicians may diagnose as either, or both at once Downloaded by Kevin Lang (dilas34153@fesgrid.com) lOMoARcPSD|31076631

● Characterized by symptoms ○ Emaciation- Person has lost substantial weight ○ People typically don’t see this as a problem, might even be proud of their body weight (saying this is what they’ve been working towards ○ Important that in diagnosing, perception of themselves weighs heavily towards their body weight/shape (obessiveness around body and food) ○ May spend much of their time thinking/obsessing about food ○ Often produces serious secondary health effects- any people die bc of their eating disorder ○ Cracked skin, fine hairs on body, problems with sexual function ○ Included amenorrhea (stopped menstruating)- removed from the DSM ■ Removed bc there were lots of ppl meeting most of the criteria but were still menstruating, denied treatment bc they got their period- saying its not that serious bc they’re still menstruating ○ High combordity with depression, OCD, anxiety disorders ● What are we saying when we diagnose a person with many different diseases? ○ Is one caused by the other? ○ May need to rethink some of this seeing high rates of comborditity ○ Person obsesses about food and body shape- should we say person has OCD and anorexia nervosa? ○ If you dont take enough food, you’l feel lathargic, sleep a lot, experience change in body weight- all symptoms of depression Bulimia Nervosa ● When a person engages in binge eating behaviour ○ Person eats far more than what would be considered normal ○ Then engage in compensantory behaviours (making up for it)- vomiting, excessive exercise, use of laxatives ○ Often happen in secret- sensations of shame, may feel comforted by the binge ● Difference between binging purging type and bulimia nervosa- depends on weight ● Persons perspective of themselves may be affected by their body weight ● Involves dangerous side effects ○ Rupturing of esophagus due to vomiting ○ High comorbidity with depression, anxiety, BPD OCD ● Doesn’t have to be daily to exist ● With binge, person feels out of control Downloaded by Kevin Lang (dilas34153@fesgrid.com) lOMoARcPSD|31076631

● Someone who engages in this behaviour has incorrect/unrealistic idea about that body part ● Obsession causes person to feel stressed and exausted ● Ppl who meet criteria for eating disorder also meets criteria of this ○ Are we saying this person has 2 illnesses? Classification of eating disorders ● Before 1960’s, no mention of eating disorders ● Asks, should binge eating disorders be included in the DSM? ○ Not so widely used in other parts of the world ○ May be more of a north american phenomenon ■ We have intense shaming about the body and eating ■ Cultural conditions create opportunity for binge eating disorder ■ May be considered as just a weird north american trend ● Changes within time; when they were young, they seemed like they had anorexia. When they got older, they seemed like they had bulimia, then seemed like they had binge eating disorder ○ Something we’re starting to see change ○ Ppl would jump around in these behaviours all the time ○ Not separate ● Shifts and changes in behaviour- diagnosis tend not to be stable Some Etiological Theory ● Social (beauty) ○ States that eating disorders caused by societal pressure to look a certain way ○ Argument: ppl look at magazines covers, watch films, scroll thru ig, see images of idealized pics of beauty involving thin women ○ As culture has emphasized thinness, amount of ppl engaging in eating disorder rises ● Evolutionary (competition) ○ Argues anorexia is an evolutionary mechanism that a person implois subconscioulsy to take a time out from the competitive world of finding a mate, producing offspring ■ Ppl who are diagnosed w anorexia are overwhemingly young, at the age they’re young, trying to send a msg to the world- don’t look at me, im not sexually available to you, don’t want to be sexualixed ■ What happens to women’s body when they start to starve themselves- stopping menstruation- loses weight- loses breasts and hips Downloaded by Kevin Lang (dilas34153@fesgrid.com) lOMoARcPSD|31076631

● Responsibility; until what point are we subject to our mental illness? ○ When diagnosing, we’re saying there are these things happening to you that you do not have control over ○ We don’t control sickness, it happens against our will ● Harm; think theoretically we diagnose someone with a mental health problem because it somehow brings harm to them; try to stop that harm ○ Ppl dont always agree on what’s harmful ○ Engaging in self harming- clear sign of mentally ill, but when we talk to those in engage in those behaviours, they feel as if it is helpful to them- escaping pain in their life, grounding themselves, etc ○ Things that may look harmful on paper to one person on a different context may not be the same for someone else ■ If you’re a politician and engaging in that behaviour, it becomes a problem ■ Symptom if a politician does it but not if you’re a student ● When should a person be treated? ○ Different perspectives ○ What is the line? ○ Things we count as mental illness may blend into normal behaviour Emergence of Hyperactivity ● Bradley home: Gave hyperactive orphans benzedrine ○ This worked and nothing happened for 30 years ○ Findings were published, but no response for nearly 30 years. Why? ■ Since distraction was an issue, there was no need for it ■ No sense that there was a mental health problem. Instead, it was thought of as childhood. Child being active, energetic was not considered a mental health problem ○ In 1957 researchers published on “hyperkinetic impulse disorder” ■ Talking about children who engage in impulsive behaviour ■ Was linked to how a person did in school- person who didn’t perform well in school was a symptom of mental health disorder ■ Researchers said all children are prone to this behaviour, but these children were “more like normal children than the ones mentally disturbed” ■ Wasn’t the same thing as a child who was running around the neighborhood killing pets ○ 10 years later, this order was talked about as an epidemic ■ How did we go to that from it not being a problem at all to being a huge problem being a threat to our health? Downloaded by Kevin Lang (dilas34153@fesgrid.com) lOMoARcPSD|31076631

Battle over Definitions ● Hyperkinesis- moving around too much ● Organic brain syndrome, minimal brain damage/dysfunction- physical problem with the child’s brain ○ Interested in what’s going on in physical organ of brain ● “Acting out”- favoured by psychoanalysts ○ Interested in parent styles ● Terms that we use are going to shape who gets diagnosed, how we will understand nature of their behaviour, and what we might do about it ● Biological approach wins out ○ Why does this approach win over other approaches? ○ Biological wins out bc its the approach with the most support ■ Governments like it bc it’s a problem within child itself and not structure around them ■ Pharmaceutical industry supports bc they produce more drugs ■ Parents support bc its not their fault ■ Satisfied greatest number of people The Shift to AD(H)D ● Shift to ADD ○ Word “ADD” removed any sense of brain instead of something like minimal brain damage ○ See rates jump up as terminology changes ○ Change what it is in a way- says that the kid is not too fidgety but stares out the window- brings in whole new group of people ○ This opened up the diagnosis to adults- suddenly become diagnostic targets ○ Shift in terminology opened up to girls being included in this (used to only apply to boys- hyperkinetic thing) ○ Stimulants (drugs) started getting used diagnostically- give person drug on suspicion- if it works, they have this condition ■ Logical problem- drugs produce an effect, does not necessarily mean you have a problem (just because you get a boost of energy from cocaine doesn’t mean they have an energy defeciency) What is a personality disorder? ● Pattern of inner behaviour that deviates merkedly from the expectations of the individual’s culture Downloaded by Kevin Lang (dilas34153@fesgrid.com) lOMoARcPSD|31076631

● Lanig conceptualized diff way of thinking about mental illness- reffered to psychosis as a sane response to insane situations- start trying to understand those things that looked pointless and so on ● Was very interested in the role of family ○ Said role of mental illness was a flexible illness- we can find different definitions on mental illness and how to treat it ■ Can be posed or positioned to benefit families ■ Anything can count as a symptom ■ When we diagnose someone, the person we’re serving is not who we’re diagnosing- benefits the people around them ○ Questioning basic assumptions of mental illness as a disease ● Says that the psychiatrist David Cooper ● Coined “anti-psychiatry” ○ Thought about everything that was wrong with psychiatry ● Said psychiatry is a social service ● Gives it the label of disease and then it’s range of services essentially exist to remove them from the public/take them out from society (taking all the people society doesn’t want and removing them from society) ● Framing psychiatry as a profession that was inherently violent ○ Violence in a name commited to protecting social norms ● Should not look at those mentally ill as “sick” ○ Ppl willing to fight against the norm ○ In his view, they were more authentic ● Marxist: society was divided between those who had a lot of power and resources and those who did not ● Society served the interest of people who were powerful ○ Not an accident that most people treated were poor or working class ○ Society structures themselves were the cause of mental illness- made people behave in ways that were unusual ○ If we’re going to solve this problem, we have to change society’s structure itseld Erving Goffman ● Conducted sociological research within psychiatric hospitals ● Goffman argued these hospitals funtioned as “total institutions” ○ Place where person’s individuality gets removed/revoked ○ People become subject to whims of authority-have to follow schedules ppl make for them, no room for self identity, got “scrubbed clean” Downloaded by Kevin Lang (dilas34153@fesgrid.com) lOMoARcPSD|31076631

● Psychiatrists are like magicians- treatment is dependent on what psychiatrist says but no clear definition or rules to play by ● Attacked historicity- rejected involuntary commitment on the grounds of dangerousness ○ because a person with the same diagnosis did something, people will do the same thing that have this diagnosis in the future ○ Removed from society against their will, put in psychiatric hospital against their will, and treated against their will- no freedom The Therapeutic State ● Essentially, psychiatry served the interest of the state by taking bunch of deviant problemtic behaviours and framing those as mental disorders ● Saw psychiatry as a coercive system to get rid of problems society doesn’t like ● Drug use, smoking, overeating, gambling, shoplifting, shyness, anxiety, etc ● Not possible to send everyone to prison, but will willingly go to see a doctor ○ Government lends their power to these physicians to diagnose ● Perspective was that people should be able to do what they want to do as long as it does not include harming others voluntarily ● Important because like the other anti-psychiatrists, he posed many difficult questions that psychiatrists had to reckon with - questions were too difficult or made them uncomfortable Ken Kelsey: One flew over the cuckoo’s nest ● Leads rebellion against authority ● Significant because he suggested that mentally ill people were essentially rebels- not playing by society’s rules ● Influenced public perception of ECT, lobotomy, instituitions, profession itself Deinstitutionalization ● Movement away from idea that mentally ill should be treated in big institutions away from the rest of society ● Hospitals around the country started to close ● Against this idea of coersion- that people should be held against their will ○ Fewer admissions, open doors ○ Community care ○ Rejection of forming ● Movement towards patient rights Failure of Deinstitutionalization Downloaded by Kevin Lang (dilas34153@fesgrid.com) lOMoARcPSD|31076631

Emergence of Survivors ● Survivor: not a person who’s survived their illness, but someone who is a survivor of the mental health care system itself ● Leonard Roy Frank: ○ Was a real estate agent but then started reading into gandhi- became a vegetarian, etc. ○ Forcibly confined after parents’ intervention, symptoms “not working, growing a beard, becoming a vegetarian, strong beliefs, negativism” ○ Received ECT 35 times and 50 insulin coma treatments in 9 months, persisted vegetarianism and beard growing cited as reaction to treatment. After “surrender”, he was released ● Network Against Psychiatric Assault ○ Advocated for hospitalized people, fought sectioning, anti-ECT, protests APA 10th annual international conference (ADD THIS SLIDE FROM PPT) Mad Pride ● Cultural festival- celebrating diversity but more a form of protest ● Celebrates mad identities, confronts shame, reclaims language, builds community From Surviving to Consuming ● “Consuming” vs “surviving” ○ Consumerism is being a part of something ○ Easier to find these days than survivor groups ● Less opposed to psychiatry generally, increase choice, make services less dependent on professional medical staff ○ Recovery bottom up, rather than top down ○ Idea is generated from themselves rather than opposed by them ● Coopted by medical sphere? Neurodiversity ● Emerged in late 1990s ● Mostly focused on autism ● Say that it’s not actually a disease, but is a natural variant of humanness ○ Same argument of being gay in the DSM ● Autism a really existing thing, an “exclusive club of difference” ● Use of internet to build community, celebration of autistic culture. Fight for group rights like other disadvantaged minorities Downloaded by Kevin Lang (dilas34153@fesgrid.com) lOMoARcPSD|31076631

Successes of Mad Activism and Neurodiversity ● Increasing consumer agency in treatment (when to be treated? With what?), how institutions are run. ● Increase in support for peer-led alternatives to medical systems ● Involvement of consumers in policy discussions- no longer so many decisions made without any input. “Nothing About Us Without Us” ● Acknowledgement of past crimes, abuses, injustices Monday November 25th Social Determinants of health Health Inequalities ● Differences in health status between groups in society Lecture 11- What do we aim to “do” when we treat someone? ● Are we trying to “cure?” Implies a definite source of distress (eg. a mental disease) that can be entirely eliminated ○ Although families and individuals might hope for cure, it’s not something that mental healthcare workers themselves typically use ● Is the goal improvement? ○ Whose improvement (eg. patients v healthcare workers)? Improving the client’s subjective sense of wellbeing? Fewer DSM symptoms? Is it about the ability to “function” in society? Downloaded by Kevin Lang (dilas34153@fesgrid.com) lOMoARcPSD|31076631

■ Need to acknowledge that things in the DSM are comprised of committees thinking about where are we drawing that ring? What are we including and not including? Group of ppl draw up this diagnostic criteria ○ Consumer involvement, transparency NIMH’s RDOC ● Thomas Insel: “I don’t see a reduction in the rate of suicide or prevalence of mental illness or any measure of morbidity...patients with mental disorders deserve better” ○ If a clinician cannot put DSM diagnosis behind your name, insurance will not cover that ○ Researcher/scientist and you need money to conduct experiment, need to tie it to something in the DSM or you won’t get money ● Ignore DSM categories, building biologically valid disorders ○ Wanna enroll everyone in this study that include eg. anhedonia ○ Want to build them new diagnostic categories that are biologically valid; wanna find all people with the same problem and scan their brains to figure out what’s the problem Other Changes: ● Does treatment work or does it create dependence? ○ Many treatments may foster dependence instead of independence ○ Drugs, hospitals ○ Not a lot of people who get treated, and then it’s done ● Dealing with professional stigma ● More time with patients ○ Reason treatments don’t work is because we’re not doing them meaningfully- not investing enough time in people ○ Limits ability to do good mental health care bc it prioritizes getting people in and out instead of creating meaningful relationships ● Shift towards dimensional model? ○ Thoughts and feeling associated with mental health problems are something all humans have experienced ○ Rather than giving diagnostic label, need to look at where someone falls along a spectrum and see what they need to do from there ● Patients consent to their label? ○ No value of labelling someone with a mental disorder if they themselves don’t find meaning in it ● Might we de-professionalize mental healthcare? ○ Psychologists control how many psychologists are made that year Downloaded by Kevin Lang (dilas34153@fesgrid.com) lOMoARcPSD|31076631