Week 5   mental disorders - lecture script
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Week 5 mental disorders - lecture script



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Week 5   mental disorders - lecture script Week 5 mental disorders - lecture script Presentation Transcript

  • Week 5: MentalDisorders: lecture script
  • Are people sad, mad, or simply bad?Is it social living or biological factors that create mental disorders?There is no uniform psychiatric view of mental disorders with manypsychiatrists disputing its causes. There is a lack of consensus as towhether mental disorders are medical problems or the result ofenvironmental causes (ie, a product of society), with some psychiatristsarguing mental disorders are really ‘problems in living’. However, theway in which psychiatrists are trained in their profession directs theirthinking towards medical causes, diagnoses and treatments (Clinardand Meier 2008, 457).
  • Constructing mental disordersMental disorder has become the preferred term to refer to mentalillness, and as such, people no longer suffer from a mental illness: insteadthey show signs of a disorder (Clinard and Meier 2008, 457-458).French philosopher and social theorist Michel Foucault critiqued theinstitution of psychiatry showing how social forces came together at a criticalperiod in time to give birth to the concepts of mental illness and psychiatrywith both growing substantially since then.Although we don’t have time to discuss it today, Foucault was highly criticalof the enlightenment movement and the development of psychiatry arguingthat instead of curing people of mental illnesses, psychiatry and mentalinstitutions became another form of social control and varied little fromprisons with people subjected to confinement and treatment that borderedon cruel and inhumane.
  • Arbitrariness of the DSM-IV• The Diagnostic and Statistical Manual otherwise known as the DSM-IV is psychiatry’sattempt to standardise diagnoses for known mental disorders. This manual was firstpublished in 1952 and has undergone a number of rewrites as definitions and features ofsupposed illnesses change. The current version is the fourth and it removes neurosis andhomosexuality from the category of psychiatric illnesses (Clinard and Meier 2008, 457).• In order to illustrate the uncertainty of disorder classification and diagnosis, Clinard andMeier explain how the third rewrite of the DSM included the category of rape as apsychiatric disorder. After much protest by feminists, this classification was withdrawn.As a result, rape is still considered a crime and not a psychiatric disorder. Clinard andMeier argue this example clearly demonstrates the arbitrariness of disorderclassifications and how political and social power influence the same. They furtherargue, the DSM provides psychiatry with the illusion of an exact medical scienceclaiming, “the DSM is not a scientific document. It presents a descriptive rather thantheoretically validated approach to diagnoses and treatment. As a result, the DSM doesnot provide reliable knowledge about the nature, causes, and cures of most mentaldisorders” (Clinard and Meier 2008, 458).
  • The two positions on psychiatricdisordersThere are two main perspectives that attempt to explain the causes ofmental disorders. These are organic and functional or environmental.Organic explanations trace the cause of disorders back to organic orphysiological sources such as senility, paresis, or alcoholism. Functionalexplanations seek the causes for disorders in society and the way inwhich people react or adjust to the difficulties of living. Thus, they areoften thought of as environmental causes as it is the environment inwhich the individual is living and their reaction to it that brings aboutthe disorder. Examples of functional disorders are compulsivedisorders, phobias, manic-depressive behaviour, paranoidbehaviour, and schizophrenia (Clinard and Meier 2008, 459-460).
  • Senile psychosis occurs through the hardening of the arteries and poor circulation affecting brainfunction. Alzheimer’s is an example of senile psychosis.Paresis is caused by untreated syphilis and results in the degeneration of brain function.Chronic alcoholism produces deficiencies in nutrients and vitamins which then cause physical andpsychological deteriorations.Compulsive behaviours are caused by “repeated actions over which people think they have little orno control”. These behaviours are context related as some actions in particular situations areperfectly acceptable. For example, excessive hand washing by a surgeon is accepted as goodpractice, whereas excessive hand washing by someone in a different environment would be thoughtto be irrational and compulsive.Manic-depressive behaviour or bipolar disorder is demonstrated by extreme mood swings wherethe individual abruptly moves from euphoria or elation to extensive brooding and deep depression.Paranoid behaviour is associated with an extreme suspicion of other people and their motives. Thistype of disorder has been subsumed into the category of schizophrenia.Schizophrenia is the most commonly diagnosed disorder and it affects young people the most.There is no single behaviour thought to constitute schizophrenia. Instead, there are a range ofbehaviours designated to the category of schizophrenic activity, such as emotional detachment andwithdrawal, inability to perform expected roles, escape into an illusionary world, imaginedvoices, and urges that disrupt daily living (Clinard and Meier 2008, 459-460).Interestingly, eating disorders such as bulimia and anorexia fall into the category of mental disordersas sufferers experience body dysmorphic disorder.
  • The problem of definitionThe classification of ‘normal’ is a highly subjective and relative exercise with many people deemed ‘normal’ notalways displaying or acting in ‘normal’ ways, and people labelled as ‘disordered’ often acting in ways that areperfectly normal. The additional reading by Rosenhan provides an excellent example of experimentation withthe concepts of normal and disordered and is highly recommended reading.As ‘normality’ is extremely hard to conceptualise, by default, mental illness or disorder defies an easy singledefinition. As a result, a number of definitional approaches are used.Statistical approaches rely on statistics to measure the degree to which individuals deviate from norms ofnormality. The problem with this approach of course is that middle range measures are used to indicatenormality which may in fact not actually correlate with the reality of normal practices.Clinical definitions rely on practitioners to judge mental disorders. In order words, a mental disorder is what apsychiatric practitioner says it is. The problem here again is the subjectiveness and broad range of definitionsthat result from individual practitioners applying their concept of mental disorders as they rely on the valuejudgments of the practitioners themselves rather than any more objective measure.A definition that is still widely held today is provided by Menninger and is “the ability to maintain an eventemper, an alert intelligence, socially considerate behaviour, and a happy disposition” represents “a healthymind” (1946, 1 cited in Clinard and Meier 2008, 463).
  • Cultural construction of normalityAs definitions of mental ill health suffer definitional problems there is no valid and reliableway to measure mental deviance that cannot be challenged. As such then, society andcultural practices play important roles in establishing the norms for normality withpractices acceptable in one society being seen as deviant in another.To demonstrate the variation in normality across cultures, Robert Bartholomew discusseswhat he terms ‘penis panic’ in Asian and Oriental cultures. Bartholomew’s article outlinesthe phenomenon known as “penis shrinking” where males in these cultures are grippedwith a fear that their penises are shrinking back into their bodies. This panic is consideredperfectly reasonable within these cultures but in our own appear irrational and delusional.Bartholomew’s paper illustrates a theory known as the ‘Thomas Theorem’ which is that“things that are perceived as real are real in their consequences” (Heiner’s editorialcomment in Bartholomew 2008, 79).Clinard and Meier cite French sociologist Bastide to demonstrate this artificial line betweennormality and disorder, “The dividing line between the two realms varies … The function ofthe psychiatrist is to search for the ‘causes’, to report on the ‘whys’ of the illness, butsociety decides who the patients will be” (1972, 60 cited in Clinard and Meier 2008, 464).
  • Some examples of cultural disorders.
  • Understanding residual normsSociologists use society as the basis for understanding disorders. It is argued “groupsestablish norms that designate certain behaviors as examples of deviance, includingcrimes, sexual deviations, drunkenness, bad manners, and other, more specific acts” suchas mental deviations. “Unlike other instances of deviance, however, the normativeviolations of mental disorder often prove difficult to specify ahead of time”. Thus they arereferred to as “residual, or left over” norms (Clinard and Meier 2008, 464).“These normative violations qualify as mental disorders when they occur outside sociallyacceptable contexts”. From this perspective, “an operational definition of mentalabnormality would look for answers to questions like ‘normal under what conditions andfor whom?’” (Clinard and Meier 2008, 465).Residual norms rely on social judgments about proper or accepted behaviours and if “aperson’s behaviour conforms more closely to the expectations of others, they tend to formmore favourable evaluations of him or her” (Clinard and Meier 2008, 465). In otherwords, we tend to accept people whose behaviour conforms to our ideals of appropriatebehaviour as normal and those that don’t as abnormal or disordered.
  • Looking for causesFrom this discussion we can establish that there are varying perspectives of mentaldisorders. The social science perspectives look at society and constructions of normality toexplain mental disorders. Biological and genetic explanations look at individualsthemselves for inherent causes for their mental disorders. Psychological perspectivessuggest mental disorders are explained by personality types with some individualspredisposed to inappropriate behaviours through social conditioning or learningexperiences. Behavioural explanations argue mental disorders are defined through arejection of an individual’s behaviour by others around that person identifying thebehaviour as deviant. This perspective is based on the social norms theory.The final perspective relies on social roles conflict to explain mental disorders. The socialroles conflict theory argues people develop mental disorders when they feel conflictedwithin their social roles, especially if they are unable to shift between roles or adapt tonew roles. Thus, the cause of mental disorders is with the individual and their reactions orperformances of their expected social roles. The correlation of this is the claim that mentaldisorders are learnt behaviours.The major criticism of this perspective is that “real, serious disturbances drive the vastmajority of psychiatric patients toward treatment” (Clinard and Meier 208, 477).
  • The role of society in the development ofmental disordersThere are clear social patterns to mental disorders.According to Clinard and Meier, “diagnoses of sever psychiatric disordersshow a disproportionate concentration in the lowest of social classes”(2008, 466). A study by the Australian Institute of Criminology looked atsocio-economic stratification by suburb or residency and the rates ofoffending and schizophrenia. What they found was that schizophrenia on itsown did not increase offending rates, however low socio-economic locationscorrelated with both high offending rates and high rates of schizophrenia(see Morgan et al 2008). The argument is out as to whether lower socio-economic conditions cause mental disorders or if people with mentaldisorders slide into lower socio-economic states. “A social selection processmay propel healthy and able individuals upward through the classsystem, while it carries mentally disordered people downward from highersocioeconomic statuses” (Clinard and Meier 2008, 467).
  • There also appear to be differences along gender lines with males having slightlyhigher overall rates of mental disorders than females. Studies indicate somedisorders are more prevalent in one gender than the other with females moreprone to manic-depressive disorders than males and males more susceptible toother types of disorders. Some researchers have put this down to higher rates ofdissatisfaction with marriage for females and their greater willingness to seekprofessional help than males. In other words, if women are more likely to seekhelp than men, then it stands to reason they would appear at greater rates in thestatistics. Remember to always consider grey and black figures in statistics.Age is also a factor with young people having higher rates of mental disorders thanolder age groups and the prevalence of mental disorders declines with age.Ethnicity also plays a role in mental disorders but as this is such a complex issue andintersects with marginalisation and socio-economic and cultural factors we can onlyhighlight the issue here.Overall, marriage appears to be a protective factor against mental disorders withdivorced, separated or never-married individuals having rates two to three timeshigher than married people.
  • Society impacts on all of these variables in multiple ways suggestingthat the stress of modern living, especially with role expectations, is amajor factor impacting on mental disorders.
  • The important role of stress in mentaldisordersIt is generally considered that a certain degree of stress is good for our personaland psychological growth as it pushes us to learn and grow. However, it is alsorecognised that too much stress or consistently high rates of stress over longperiods of time are particularly detrimental to psychological health. Although thereare other important factors that can contribute to mental health disorders such aschemical imbalances in the body or genetic predispositions to such disorders, thereis growing recognition of the role of stress on the development of these disorders.Thus, a tool for measuring stressful life events has been developed. Research hasfound those who commit suicide often measure the highest numbers of theseevents, with those suffering from depression next highest, followed by those withschizophrenia (Clinard and Meier 2008, 469).Although it must be pointed out that not everyone experiencing these events willdevelop a mental disorder as some people have better adaptive practices thanothers.
  • Complex intersectionsThere are a number of other serious social issues that intersect withmental health problems. These arehomelessness, unemployment, substance abuse, a history of sexualabuse, crime, and suicide. According to the Mental Health Council ofAustralia, 85% of homeless people have a mental health problem. 75%of people with drug and alcohol problems also have mental healthdisorders. ABS records indicate the unemployment rate for peoplewith mental disorders was 4% in 2007 compared to 2.7% for the rest ofthe population. Gender increases this gap with female unemploymentrate for people with a disorder increased to 8% compared to 3% formales.
  • There is also a strong correlation between people with mentaldisorders and crime. Research by the Australian Institute ofCriminology found at least half of the offenders surveyed had a historyof mental health problems (Forsythe and Gaffney 2012).
  • Likewise, there is a strong link between a history of child abuse, crimeand mental health disorders, this is especially so for female offenders.
  • StigmaThere is still much stigma attached to mental disorders in society. Accordingto Clinard and Meier, there are a number of factors which contribute to thisstigmatisation of people with mental disorders. The first of these is the ideathat people cause their own mental health problems. Unlike medicalproblems, mental health issues are often subconsciously thought to becaused by a deficit within the individual themselves. Secondly, the caresystem for addressing mental health problems is often separated frommedical care systems thereby reinforcing this distinction between the twotypes of health problems. And thirdly, there is a prevailing belief within thegeneral population that people with mental health issues are unstable anddangerous. This belief has increased over recent decades and is linked to therise of risk thinking in western countries.The stigma of mental disorders impacts on individual’s ability to acquireadequate housing, employment, and maintain functional relationships.
  • Addressing the problemThere are a number of strategies used to respond to mental health issues.The first is voluntary medicalization. In these cases, individuals seek help fortheir problems which are then managed by a professional almost always withmedication allowing the person to remain in the community.Some individuals require confinement, usually at a psychiatric care facility.This may be for a short period of time to introduce new medication orstabilise current medication. Much longer periods of confinement orpermanent institutionalisation occurs through forensic units resemblingprison units. These facilities house individuals considered too dangerous tobe allowed to remain in the general community. These facilities act ascustodial centres rather than treatment centres.
  • Deinstitutionalisation started in earnest back in the 70s and 80s on the backof public concern over how people were being treated in psychiatricinstitutions. As a result of this movement, the care for people with mentaldisorders was shifted into the community with many people now treated byprofessionals whilst remaining in their own homes etc. Care homes muchlike boarding facilities were established to house those who needed minorsupervision in the community, but generally, responsibility for these peoplehas been shifted to the individuals themselves and the community at large.As a result, many charitable organisations have taken on the role of providingsupport to people with mental disorders through community programs etc.Problems arising from this model are studies show community organisationsare unable to meet the needs of all people in society with mental disorderswith many not receiving any treatment or support at all. Many patientstoo, especially when their conditions are not appropriated controlled, findhospitalisation a relief but with scant resources channelled into thesefacilities many are unable to access this help and take drastic actions such asviolent behaviours or suicide attempts in order to escalate the prioritisationof their case.
  • Statistics for AustraliaThe statistics for Australia paint a pretty sombre picture of mental health disordersin this country. Almost half the entire population will experience a mental disorderat some point in their lifetimes. 20% of the adult population experienced a mentaldisorder in a 12 month period. Of these, 6.2% or nearly 1million Australians had anaffective mood disorder, 14.4% or over 2.3million had an anxiety disorder, and 5.1%or over 800,000 had a substance use disorder. As a result, mental health disordersand suicide account for 14.2% of Australia’s total health burden which equates to374,541 years of healthy life lost. Mental health issues cost states and territories$3billion in the 2007-08 period.Of even more concern, it was found that only 1/3rd of people with a mentaldisorder used health services to manage their condition. This means 2/3rds ofpeople with mental disorders do not seek or receive any help or support to managetheir conditions.It is estimated that depression will be one of the leading social problems in theworld by 2020.(source: Mental Health Council of Australia).
  • Direct students with concerns to supportservicesReferencesAustralian Bureau of Statistics. 1301.0 – Year Book Australia, 2009-10.http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/1301.0Chapter11082009%E2%80%9310Bartholomew, Robert E. 2008. “Penis Panics”, in Deviance across cultures, edited by Robert Heiner, 79-85, Oxford, Oxford University Press.Forsythe, Lubica and Antonette Gaffney. 2012. “Mental disorder prevalence at the gateway to the criminaljustice system”, Trends and Issues in crime and criminal justice, Australian Institute of Criminology, No. 438.Forsythe, Lubica and Kerryn Adams. 2009. “Mental health, abuse, drug use and crime: does gender matter?”Trends and Issues in crime and criminal justice, Australian Institute of Criminology, No. 384.Humphrey, John A. 2006. “Mental illness”. In Deviant behavior, 144-165, New Jersey, Pearson Prentice Hall.Mental Health Council of Australia. 2007. Fact Sheet: statistics on mental health. www.mhca.org.au.Morgan, Frank, Vera Morgan, Joe Clare, Giulietta Valuri, Richard Woodman, Anna Ferrante, David Castle andAssen Jablensky. 2008. “Schizophrenia and offending: area of residence and the impact of socialdisorganisation and urbanicity”, Trends and Issues in crime and criminal justice, Australian Institute ofCriminology, No. 365.Rosenhan, David L. 2008. “On being sane in insane places”, in Deviance across cultures, edited by RobertHeiner, 235-242, Oxford, Oxford University Press.