Psychology Revision

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Psychology Revision

• Clinical Psychology

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What Is Abnormality?

• Deviation from the social norm.
• It allows minority groups to be classified.
• It seems intuitively correct, we tend to think of
  mental illness as people behaving abnormally,
  I.e., against the social norm those with mental
  illness often do break social norms.
• This may not be a good gauge of abnormality
  because our idea of normality changes over time,
  e.g., homosexuality is no longer against the
  social norm there are also cultural variations
  with regard to social norms.
• Criminals often break social norms, but are not
  thought of as mentally ill.
• Not everyone who suffers mental illness will
  break social norms, e.g., those with clinical
  depression, intense anxiety.
• Deviation from the social norm is not always
  indicative of mental illness, e.g., frequency
  context of behaviour also need to be taken into
  account (wearing pyjamas in the street might be
  abnormal, but not in an emergency, such as your
  house catching fire)

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What is Abnormality?

• Deviation from the statistical norm.
• If most people can do something, it seems logical
  to assume those who cant must be abnormal.
• It provides a clear cut-off point for those who
  are different. However, being different does
  not classify abnormality.
• It can be a good thing to deviate, e.g., gifted
  talented people deviate from the statistical
  norm in a good way.
• Sometimes statistics can change, e.g., IQ levels
  have increased over the past 100 years, this
  implies that someone with a certain score 100
  years ago would now be regarded as mentally
  retarded.
• Homosexuality is statistically abnormal but this
  does not mean that homosexuality should be
  categorised as a form of mental illness.
• Statistics arent always a valid measure of
  something (e.g. Intelligence).
• One score may not accurately reflect behaviour or
  cognition it may also be necessary to use more
  than one measure ( more than one score) to get
  an accurate gauge of statistical average
  behaviour/attitudes.

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What is abnormality?

• Personal Suffering/Distress
• It is good because it takes into account the
  subjective nature of suffering it is different
  for everybody
• However, some people may not be aware of their
  condition
• People have different ideas about what it is to
  suffer it is therefore very hard to measure
  quantify so too subjective to be of much value
• Some may exaggerate symptoms when defining mental
  health
• It relies on the sufferer to show signs of their
  condition
• Psychopaths may feel no distress whatsoever but
  are nevertheless regarded as having a clinical
  condition
• Failure to function adequately
• Maladaptiveness of behaviour when the behaviour
  is not adapted well to a situation then it will
  cause abnormality
• Condition is often very obvious
• However, it is based on value judgements - too
  subjective
• Society may be the problem, not the individual

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What is abnormality?

• Absence of normality
• Deviation of the expected - the mental health
  criteria
• Jahoda (1958) wrote criteria for ideal mental
  health
• Freedom from mental illness
• Self-actualisation
• Autonomy
• Mastery of the environment
• However, these are based on value judgements
• Values change all the time
• Highly context-significant
• It is difficult to keep with definite
  characteristics
• People have different ideas about
  self-actualisation/none at all

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Problems with defining abnormality

• The problems with all of these definitions is
  that there is no one, shared characteristic
  implying that no one definition is enough
• Theres no fixed point between normal and
  abnormal - a continuum

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Classification Systems

• Advantages
• Allows people to get treated more effectively due
  to more minority groups not lumping people
  together
• A way of investing different situations
• Allows people to pool information and research
  that group
• The first step towards diagnosis gt treatment

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Validity

• Aeitological Validity
• That people with a particular disorder have the
  same causal factors
• Concurrent Validity
• When you have on-set of symptoms, you have
  associated conditions e.g. age of onset, social
  factors
• Predictive Validity
• Whether the results match up with whats predicted

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Validity

• The Diagnosis should be a genuine accurate
  reflection of the condition diagnosed. This is
  not as straightforward as it seems
• Rosenhan (1973) Being Sane in Insane Places is
  a classic study which shows the problems of
  validity with regard to clinical conditions.
  (NB., One Flew Over The Cuckoos Nest).
• Bi-Polar Disorder (manic depression) is often
  misdiagnosed as Schizophrenia because the
  symptoms can be very similar.
• Different types of conditions may often have
  similar symptoms, e.g., paranoia is associated
  with schizophrenia substance abuse

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Reliability

• Both physical and clinical conditions are not as
  easy to diagnose as you may expect
• Reliability for angina and tonsillitis is lower
  than that of schizophrenia
• Cooper et al. (1972) showed psychologists had
  different diagnoses for the same conditions when
  watching a video clip of patients. Americans were
  twice as likely to diagnose schizophrenia than
  British, who diagnosed bipolar disorder more
  often. This proves that a classification system
  relies on more than just symptoms
• Spitzer Williams (1985) found that
  psychologists agreed on a diagnosis only 50 of
  the time
• Zigler Phillips (1961) found that agreement for
  clinical categories was 54-84 e.g. personality
  disorders

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Reliability

• Kendell (1975) found only a 33-57 agreement
  about more specific definitions
• Davison Neale (1994) Psychosexual conditions
  are more reliable (92) because it is easier to
  diagnose unlike any other disorder. For
  somatoform disorders it drops to 0.54
• Fallek Moser (1975) found a 66 concordance
  rate with the post mortem and the cause of death
  on the certificate
• A problem with a lot of diagnoses is that they
  are nebulous (vague)

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Interviews

• Often the diagnosis takes place through a
  clinical interview, which are unstructured so the
  same questions arent asked each time so
  different conclusions can be drawn through the
  different information
• Self-report is also another unreliable method to
  diagnose conditions
• These methods lack objectivity so reliability and
  validity are harder
• Doctors may not be given the same information
  each time and in the same manner
• Doctors also only spend a short amount of time
  with each patient, so accurate diagnosis is
  difficult
• Some people may exaggerate symptoms to get a
  result (e.g. faster cure, sick leave etc.)

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Classification Systems

• General Problems
• Creates a circular argument
• Do symptoms classify the illness or does the
  illness classify the symptoms
• They may not help if theres no treatment
  available
• Mental health is a continuum, and there is no
  clear cut-off point, so conditions will not fall
  into a particular category
• Goffman argues that classifying people
  stigmatises them
• It attaches a negative label, to which people
  will make assumptions which is unfair
• Scheff believes that this will induce
  self-fulfilling prophecy, whereby people will
  live up to their label
• Heather introduce the concept of
  institutionalisation, believing that people can
  become dependant on their surroundings

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Classification Systems

• General Problems
• Szasz thought that classifying people often
  caused them to medicalize behaviour
• meaning they will use drug treatment for all
  behaviour, when really the people are just
  unpredictable people who have problems with
  living. By classifying them, society is trying to
  control unpredictable people. It is easier to
  blame an individual than to blame society.
• Blaney (1975) however, believed labelling people
  was quite humane.
• Its not saying that you are bad, but merely
  allowing you to know its not your fault
• Sometimes however, the condition can be used as a
  scapegoat for people who do not take
  responsibility

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Classification Systems

• General Problems
• R.D. Laing thought that schizophrenia is not a
  breakdown, its a break-through.
• To deal with it rationally, and confronting it is
  better than just labelling it as a disorder
• It has focus more in the individual, and not the
  cause (e.g. families)
• It diagnoses the symptoms and not the individual
• It should not be diagnosed due to social norms
• McCrae and Costa (1992) introduced a theory of
  5-factor analysis
• Agreeableness Openness to experience/Not
• Stable/Neurotic
• Conscientious/un-conscientious
• However this approach only applies to
  personality, and there is not clear cut-off point
• It ignores social facilities, subjective distress
  and biological factors

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International Classification of Disease (ICD)

• ICD
• This involves one broad category, and describes
  symptoms
• It matches references between causes
• It is more 1-dimensional than the DSM
• It links class and culture, looking at a variety
  of cultures, not like DSM, which is westernised
• However, this can cause a lot of cultural
  baggage to be carried

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Diagnostic Statistical Manuel of Mental
Disorders (DSM)

• DSM is the US method of diagnosing mental
  disorders (NB., Western psychiatric bias).
• It is a multi-axial system there are 5 axis.
  For a diagnosis to be made the patient must meet
  criteria on at least the first 3 axis (although
  all 5 are considered).
• Evaluation of DSM
• DSM is continually updated to take into account
  new research changes in cultural attitudes,
  this helps to improve reliability validity.
• The inter-rater test-retest reliability of some
  disorders is now very good however, other
  disorders remain low, notably childhood disorders
• The multi-axial nature of DSM improves validity
  because diagnosis is not based on one aspect or
  feature of behaviour/cognition, social factors
  level of personal functioning is also considered,
  for example.
• DSM has been prone to cultural/social bias, e.g.,
  homosexuality was on DSM until 1980, now Maths
  phobia is on DSM.

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Cultural factors affecting the diagnosis of
clinical conditions

• Cultural ideas differ in some cultures, and
  between some cultures
• Banyard (1996) found that 5 of the UK population
  is black, but 25 of psychiatric patients are
  black
• This could be due to racism, or that its harder
  to be a minority group therefore more conditions
  arise, or diagnoses could be culturally biased
  (made by white, middle-class Drs)
• Lilwood (1992) believed axis V (G.A.S. (1-100))
  placed too much emphasis on the nuclear family.
  Different families have different cultural
  traditions, and behaviour is different for
  different cultures
• Davidson and Neale (1994) found that
  Asian-American women are seen as more
  subservient/withdrawn. Emphasis may be placed on
  a disorder, but their culture may make their
  behaviour normal to them
• It can be bad to acknowledge some cultural
  differences
• OConner (1989) found native Americans get lower
  IQ scores than white Americans. This is because
  the IQ test is designed from a western
  perspective. Western influences often emphasise
  the importance of the individual, and not the
  importance of teamwork, which is favoured in
  other cultures

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The importance of cultural factors with
classification

• Rack (1982) found that rates of depression are
  very low in Asian countries, which would suggest
  that aetiological factors are restricted to
  western cultures ? status anxiety? Too much
  choice?
• However, he realised that rates were actually
  similar, but those in more eastern cultures are
  more reluctant to seek help for depression due to
  the stigma attached to depression as a mental
  illness. In China, it was found that people only
  went to seek help for mental disorder when the
  symptoms are undeniably clear
• Cochrane (197) discovered that black people were
  between 2 and 7 times more likely to be admitted
  to an institute with schizophrenia. If you were
  white, you were also more likely to be admitted
  with less severe symptoms.
• Symptoms are more recognizable in white people so
  they are more likely to be admitted early ? white
  psychiatrists have similar cultural frames of
  reference.
• It could also relate to the access of healthcare.
  There is less understanding because few doctors
  are black/Asian. This could be due to social
  drift ? when you slide down the social ladder
  when youre mentally ill. People with a lower SES
  are less likely to be registered with a GP.
  Ethnic minority groups are usually lower un the
  SES ? language problems?

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The importance of cultural factors with
classification

• Brislin (1993) thought that there are at least 3
  possible ways in which culture influences
  clinical conditions
• The form the symptoms take (how they show
  themselves)
• Different cultures have different ways of
  manifesting symptoms
• E.g. 1920s ? schizophrenics heard voices through
  the radio, 1950s ? they heard voices through the
  TV, 1960s ? space, 1980s ? microwaves
• Triggers (precipitatory factors) in different
  societies are different
• Haughton (1972) found that primitive African
  tribes with problems would talk to a witch
  doctor, who would try and find out who cast a
  spell on them, Often illness was caused by
  stress, so the poor relationships were improved,
  therefore reliving stress
• Prognosis in different cultures is different
• Kleinman Lin (1988) thought it would be better
  to have schizophrenia in non-westernised
  countries because the lifestyle is much simpler.
  Non-westernised cultures have a higher emphasis
  on family values, so there is less chance of
  social isolation, and you can fit into society
  better with their support
• Self-worth ? can be low due to poor social
  interaction, with which drugs cant helps
  therefore there's lower self-worth in cultures
  where society isolates those with mental problems

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The importance of cultural factors with
classification

• Culture bound syndromes
• When we define mental illness, its usually done
  by a middle-class, white person, so anything
  thats not usual to this culture will be ignored,
  or unclassified, so they are often
  under-diagnosed
• Fernando (1991) thought that many illnesses
  classified using western classification systems
  dont recognize other forms of abnormality they
  dont accept forms that go against the paradigm ?
  ethno-centric bias
• Some conditions are diagnosed more frequently in
  one gender than another, which suggests a
  gender-bias in diagnosis.
• However, this could be due to the socialization
  of women/men, and their willingness to see the
  doctor. There may also be some genuine biological
  factors in diagnosis
• HISTRIORIC PERSONALITY DISORDER ? extrovert, OTT
  associated with women, drama queen
• DEPENDANT PERSONALITY DISORDER ? clingy,
  attached associated with women
• NARCISSISTIC PERSONALITY DISORDER ? Obsessive
  vanity associated with men
• OBSESSIVE COMPULSIVE DISORDER ? diagnosed more in
  men
• These prove how our socialized impressions of men
  and women give us pre-conceptions of their roles.
  Some of these conditions may be diagnosed if the
  behaviour is away from our socialized norm

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The importance of cultural factors with
classification

• Too much emphasis on differences in cultures may
  mean that if one culture suffers from a problem,
  they will all be ignored ? its a part of their
  culture, which could lead to under-diagnosis
• However, there is an over-diagnosis in some
  cultures (e.g. black people and schizophrenia)
• With these problems its often easy to avoid the
  importance of diagnosis

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Approaches clinical psychology

• The Biomedical Model

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Outline of biomedical approach

• Clinical conditions can be understood in the same
  way as physical disorders. Emphasis on
  biological/physiological explanations, e.g.,
  genes, neurotransmitters (serotonin, dopamine
  hypothesis, brain structure).
• Focus is on physiological aspects of mental
  disorder rather than behavioural, cognitive,
  emotional or social aspects.
• Clinical conditions can be treated physically
  because they are physical in cause, I.e., through
  chemotherapy (drugs), ECT, psychosurgery.

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Evaluation of biomedical model

• Evidence for biological explanations from twin
  studies, e.g., Gottesman concordance for MZ
  twins schizophrenia. Evidence for dopamine
  hypothesis, serotonin levels in depression.
• Biological treatments for clinical conditions can
  be very effective, e.g., anti-depressants,
  anti-psychotics, ECT for severe clinical
  depression.
• Side-effects of drug treatments, problems of
  dependency.
• Treats symptoms not underlying cause of problem.
• Problems of cause and effect, i.e., is
  schizophrenia caused by too much dopamine or does
  the condition itself lead to too much dopamine
  being produced? I.e., behaviour may affect
  biology, not the other way around.
• Concept of no blame i.e., person cannot help
  their condition because it is physical and beyond
  their control BUT does this remove personal
  responsibility from person with illness to the
  health care professional.
• Biomedical explanations ignore contributions made
  by social psychological factors.

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Behavioural model

• Clinical disorders are explained as patterns of
  learned maladaptive behaviour.
• Focus is on observable behaviour as opposed to
  physiological, emotional, cognitive or social
  factors.
• We learn maladaptive behaviours through processes
  of classical and operant conditioning and social
  learning theory.
• Mental disorders can be treated using behavioural
  therapies which aim to replace maladaptive
  behaviour with adaptive behaviour through
  classical operant conditioning e.g.,
  flooding, aversion therapy, token economies.

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Evaluation of behavioural model

• There is lots of empirical evidence to support
  the concepts behind behavioural model although
  a lot of this research has been done on animals.
• Behavioural techniques have proved effective in
  treating some types of disorders, even some of
  the behavioural aspects of schizophrenia.
• Avoids labelling person, I.e, they have not got
  an illness but maladaptive behaviour, it is the
  behaviour, not the person, that is the problem.
• This approach simply focuses on the outward
  manifestation of the problem the behaviour, not
  the underlying cause of this behaviour. This can
  lead to symptom substitution where one symptom
  or behaviour is treated but re-emerges or
  manifests itself as another type of maladaptive
  behaviour.
• It underestimates the complexity of humans, we
  are simply learning machines at the mercy of
  our environment, cognitive factors (mental
  processes) intervene between stimulus response.
• It seems unlikely that complex clinical
  conditions can be learned.

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The cognitive model

• This approach aims to explain specific features
  of clinical conditions, rather than the illness
  in its entirety, e.g., cognitive approach can
  explain symptoms of schizophrenia such as thought
  insertion, or poverty of speech thought
• The cognitive approach focuses on cognitive
  processes such as memory, distorted/irrational
  thinking other perceptual problems, rather than
  biological, behavioural, emotional or social
  problems.
• Cognition can affect physiological functioning
  vice versa.
• If symptoms of mental illness are cognitive in
  nature, then treatment should involve tackling
  cognition, i.e., challenging irrational beliefs,
  distorted thinking. E.g., Ellis ABCDE paradigm
  Aactivating experience Bbelief Cconsequences
  DDisputing belief Eeffects of successfully
  disputing belief. Becks cognitive
  triadNegative view of self Negative view of
  future Negative view of world
• Beck argued that automatic negative thoughts
  overwhelmed people with clinical problems.
• Mental illness can be explained by negative
  self-schemas which often develop early in
  childhood.
• The role of the cognitive therapist is to suggest
  to the client new ways of interpreting situations
  perceived as negative.

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Evaluation of cognitive model

• There is much scientific support for this
  approach, e.g., Gustafson (1992) found that
  maladaptive thinking processes were displayed in
  many people with psychological disorders, such as
  depression, anxiety sexual disorders.
• There is also a lot of support for Becks
  Elliss cognitive model of mental illness.
• There is little empirical support for the concept
  of schemas in relation to mental illness.
• The cognitive model emphasises the role of
  individual being self-sufficient (the
  individual can almost think themselves better)
  therefore, it tends to devalue social support
  systems and places responsibility for issues
  with the individual, not the social environment.
• Cognitive-behavioural therapy has been shown to
  be very effective with a range of disorders,
  especially clinical depression, but also
  schizophrenia.
• Treatment, like the behaviourist approach, is
  practical problem-solving in nature, but is
  also empowering for the individual as they can
  learn to control the excessively negative
  thoughts emotions which can detrimentally
  affect their lives.
• Between 50-60 of depressed clients treated with
  cognitive therapy show total remission of
  symptoms (Hollon et al., 1993)
• Improvements in self-concept produced by
  cognitive therapy correlate with lifting of
  depression (Pace Dixon, 1993).
• However, the demand for cognitive therapy to
  treat clinical depression often outstrips the
  supply of trained psychology professionals.
• Like the biological model there are problems with
  cause effect, i.e., maladaptive thinking
  processes may be the result and not the cause of
  the psychological disorder, e.g., low serotonin
  levels may lead to depressed thoughts, or
  depressed thoughts may result in lower serotonin.

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The psychodynamic model

• The focus is on early relationships, especially
  with parents, and how this can affect mental
  health well-being in later adult life.
• Early traumatic experiences are associated with
  later mental health problems.
• These early experiences are retained in our
  unconscious mind affect our later conscious
  feelings, motives relationships.
• We often use defence mechanisms to prevent use
  from confronting these traumatic experiences,
  which often result from conflicts between the
  demands of the id, ego superego.
• Freud used the term hydraulic model to explain
  his concept of personality we often bury trauma,
  conflict repressed emotions but this can lead
  to a build up of pressure (hence term hydraulic)
  tension which needs to be vented in some way,
  I.e., we have to figuratively blow off steam in
  some way.
• Treatment involves uncovering these unconscious
  elements through psychoanalysis in order to
  achieve catharsis the safe release of this
  unconscious tension/psychic energy.

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Evaluation of the psychodynamic model

• Some aspects of Freudian theory have support,
  especially notion of importance of early
  childhood experience, e.g., Brown Harris.
• However, many other aspects of theory have little
  scientific support are difficult to test
  empirically because they are subjective revolve
  around the unconscious (NB., just because
  something cannot be scientifically tested does
  not mean it is not necessarily correct.)
• Freuds theory was based on a limited atypical
  sample.
• Freud was instrumental in changing the way we
  think about mental illness and psychoanalysis
  (and Brief Dynamic Therapy) have been shown to be
  effective in treating some forms of mental
  illness (and are better than treatment at all).
• Psychoanalysis can take months or even years, and
  therefore can be expensive.

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The Humanistic Model

• People have a basic tendency to grow fulfil
  their potential to self-actualise
• Problems arise when a person cannot realise their
  full potential and is prevented from doing so
  because of the demands/constraints of society
  family etc. People cannot self-actualise because
  they make personally inappropriate life-choices
  which prevent them from exercising their
  potential being true to themselves.
• Where incongruence exists, a large gap between
  self-concept and ideal self, a lack of
  self-esteem can result and this can prevent an
  individual from making life choices that they
  want to. Incongruence can result through a lack
  of unconditional positive regard and a sense of
  doing things to get positive regard from others.
• Hence there is a strong association between
  mental health and having a healthy self-image and
  strong sense of self-esteem.
• The primary concern of this approach, like the
  psychodynamic approach, is on emotion, as opposed
  to biology, cognition or behaviour.
• People are essentially future-orientated, and
  under the right circumstances will make the best
  choices for themselves. The aim of this approach
  is to help people make the right choices and so
  fulfil their human potential. Therapists
  (practising person-centred therapy) need to
  exhibit three core characteristics to help their
  clients achieve this Empathy, Congruence/Genuinen
  ess, Unconditional Positive Regard/Non-Judgemental
  .

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Evaluation of the Humanistic model

• Numerous studies have supported a link between
  parenting style, self-esteem and mental health.
  Research has shown that children with higher
  self-esteem have improved self-concept which has
  also been associated with greater achievement (or
  actualisation). Lau Pun, 1999 Burnett,
  1999.
• However, it is generally argued that the
  humanistic approach does not lend itself to
  scientific (empirical) research easily, thus the
  scientific evidence supporting this approach can
  be limited.
• Related to the above point, the concepts in the
  humanistic approach, e.g., self-actualisation
  self-concept, can be quite vague/nebulous and
  subjective, making them hard to quantify and
  measure objectively (key features of scientific
  study).
• Many people never self-actualise but still some
  to be perfectly happy.
• Person-centred therapy, with its emphasis on
  personal growth, rather than illness, avoids the
  problem of labelling or stigmatising an
  individual. However, it has been argued that
  this approach is often overly optimistic about
  the human condition and experience. It is also a
  reflection of the American culture it emerged
  from, i.e., it focuses on the individual which
  may be a good thing in some respects but it
  disregards social and environmental factors which
  may be beyond the control of the individual,
  e.g., jobs, housing.
• The humanistic approach requires a certain amount
  of personal insight, in order to be able to talk
  about ones own experiences and choices in many
  cases people suffering from more profound
  clinical condition have limited or no insight
  into their condition.
• Person-centred therapy concentrates on the
  individual not the problem. However, while this
  might be a good thing most of the time, there are
  some situations where the problem may need
  addressing, e.g., a neurochcemical imbalance.
• Rogers did not explain in the same detail as
  alternative theories, e.g., cognitive, social
  learning theory, exactly how parenting,
  self-esteem and mental health are linked.
• This apporach may be useful for people to whom
  spirituality is important.

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The Social Model

• The development of diagnostic categories, such as
  schizophrenia, anxiety disorders, affective
  disorders, and the actual process of diagnosis is
  rooted in social processes, e.g., making
  judgements about what is and is not abnormal.
• Social factors, such as poor relationships
  family communication (expressed emotion), low
  socio-economic status related issues, may
  predispose or precipitate a clinical problem.
• The emphasis is on social explanations of
  disorders rather than on individual emotional
  experiences, or other psychological biological
  factors. E.g., feminists emphasise the role of
  the relative social power of ment women in the
  development of mental disorders in women.
• Clinical problems can be treated using social, as
  well as psychological biological interventions.
  E.g., care-in-the community programmes, drop-in
  centres, social skills training and help with
  day-to-day living.
• Traditionally people suffering from mental health
  problems where placed in mental institutions,
  where, as Goffman (1968) argues, they would be
  subject to social control and become
  institutionalised.
• R.D. Laing famously suggested mental illness was
  a fairly rational response to the sense of
  alienation felt by many and to the intense
  pressure of family life society people are
  obsessed with maintaining the status quo and
  strive to maintain their own definition of
  reality Madness need not be breakdownit may
  also be breakthrough
• Thomas Szasz, The Myth of Mental Illness, argued
  that mental illness is better viewed as a problem
  in living, which is socially expressed, rather
  than an mental illness he argued against the
  medicalisation of what he regarded as
  essentially social problems. He suggested
  clinical diagnosis is a form of symbolic
  recapture, where society tries to predict an
  individuals behaviour, yet because mentally ill
  people are unpredictable society tries to label
  stigmatise such people in order to make them more
  controllable, I.e., they are hospitalised or
  given chemotherapy to make them more pliable and
  predictable.

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Evaluation of the Social Model

• Social explanations provide a contrast with the
  individual explanations offered by other
  biological psychological perspectives.
• There is some evidence to suggest a link between
  social factors, e.g., social relationships
  socio-economic status and mental illness, e.g.,
  Brown Harris (1978) Expressed emotion and
  rates of relapse for schizophrenia (Brown, 1973)
  NB., this only supports factors to do with
  relapse and not causation.
• Consider evidence for against social drift
  social causation as explanations of clinical
  disorders.
• Care-in-the-community is seen as a better, more
  effective and ethical treatment of mental illness
  than other treatments, such as hospitalisation
  and chemotherapy, as it avoids the problems
  associated with institutionalisation and
  subsequent labelling and stigmatisation and the
  problems of dependency and side effects of some
  drug therapies. Patients in care-in-the-community
  programmes are often happier and make better
  progress than long-term hospitalised patients
  (Hogarty, 1993). Care-in-the-community allows
  patients to retain family friendship ties
  support more easily.
• However, care-in-the community programmes,
  drop-in centres, 24 hour helplines etc.are often
  not well-funded (mental illness is often not seen
  as a funding priority), or coordinated and there
  is often a lack of expert/skilled mental health
  practitioners available.
• If the social environment is the cause of the
  problem and cannot be influenced then other forms
  of treatment might be more effective.
• Evidence shows that the supportive atmosphere of
  half-way houses aids recovery from schizophrenia.
• Lack of continuity in who deals with patient may
  lead to problems.
• If patients are in the community it may be more
  difficult to ensure compliance with drug
  therapies due to lack of control. This can in
  turn lead to the revolving door syndrome.
• The presence of support in the community does not
  mean patients will use it.
• Social explanations are often regarded as merely
  incidental to, or amplifications of other
  biological/psychological explanations, not as
  explanations in themselves (per se). They are
  usually incorporated into a diatheis-stress
  explanation of mental illness (I.e, there is an
  underlying biological or psychological cause
  which requires some kind of external/social
  trigger in order for the disorder to manifest
  itself and develop.

36
Therapies Treatment

• The Medical Model
• This states the idea that mental problems are
  caused by physical malfunctions ? treatment must
  be physical also
• Psycho-surgery
• Surgical processes to alter psychological
  malfunction
• Freeman and Watts (1942) developed modern frontal
  lobotomy, but lack of scientific nature,
  unpredictability and its side effects meant that
  it was not done
• Psycho-surgery is now used, and is treatment for
  conditions like OCD, depression and violent
  behaviour

37
Therapies Treatment

• Chemotherapy
• Use of drugs to treat psychological conditions
• Used to treat schizophrenia and steroid abuse
• Drugs are used to block dopamine receptors
  (post-synaptic sites) in the brain
• SSRI Serotonin levels are affected to treat
  depression
• They often have unpleasant side effects
• With drugs theres often a strong chance of
  relapse
• They can take up to 4 weeks to work
• Electronic Compulsive Therapy (ECD)
• Electrodes are attached at 110V for 30s 4 mins
  through temples
• Treats depression, bipolar disorder and OCD
• Used on 20,000 people p.y
• Much quicker than drugs therapy
• High success rate, but the treatment is very
  unpleasant

38
Therapies Treatment

• The Social Approach
• Community Psychology
• Good mental health from correct interaction with
  community environment
• Against institutionalisation because it prevents
  people from interacting with others in a normal
  way ? we shouldnt marginalize people
• Emphasises the environment as the cause and
  treatment from mental problems
• Half-way houses
• A good way of receiving support and treatment,
  without becoming institutionalised
• Home care
• They can remain with their families, and still
  receive treatment
• But this can cause pressure for the family, and
  may cause stress ? more problems develop
• 24-hour care
• A telephone service that allows people to have
  someone to talk to all the time
• ST Inpatient care
• A drop-in program in hospitals for mental
  health care

39
Therapies Treatment

• The Cognitive Approach
• Believes that mental problems come from
  maladapted thought processes
• Aim is to change self-defeating assumptions
• Rational-emotive therapy
• To find flaws in their thinking, and break the
  cycle of poor thinking
• Attribution Therapy
• Finds the flaws in attributive thinking ?
  internalising things can cause distress
• Cognitive behavioural therapy
• Change behaviour through changing thinking about
  that behaviour
• Self-efficacy
• We look at other people and believe that we can
  do something

40
Therapies Treatment

• The Humanistic Approach
• Believe that mental problems stem from issues
  with personal growth
• This approach focuses more on the individual, and
  their view on the world
• Therapists needs to act genuinely, and with
  unconditional positive regard, as well as
  accurate, empathic understanding
• Self-actualisation is important ? being able to
  focus on the present and the goals in life
• The emphasis needs to be on freewill etc. to
  develop p. growth, so structure needs to be free
• Existential Therapy
• logo therapy for those with anxiety disorders
  and phobias
• If you can wish the worst case of your fear upon
  yourself, then you cannot over-anticipate the
  problem
• Client-centred therapy
• Healthy people are aware of behaviour, and are
  good and centre effective
• Therapist will give the opportunity for these
  things to happen
• It relies on the assumption that people are
  essentially good

41
Therapies Treatment

• The psycho-dynamic Approach
• Hypnosis
• Although Freud did not agree with hypnosis, it is
  believed that it can help to uncover thoughts
  from the unconscious
• Free association
• The ego acts as a censor to the information, so
  free association can get past this by not
  allowing the ego to cover information before it
  leaves the unconscious
• This is the most widely used therapy
• Dream interpretation
• The dreams offer a solution in terms of dreams
  being unconscious wish fulfilment
• They can help offer information from the
  unconscious

42
Therapies Treatment

• The Behavioural Approach
• Shaping
• Rewarding behaviour as it gets closer to the
  desired outcome
• Can be used to improve social interaction in
  autistic children and schizophrenics
• TEP
• Tokens act as secondary reinforcers, and research
  has proven that both animals and humans will
  continue behaviour for reinforcement at a later
  time
• It has been proved useful in personal care and
  social development, particularly in institutional
  environments
• However, it can make participants dependant on
  tokens
• Aversion Therapy
• Works by associating negative stimuli with a new
  response
• Uses the principles of classical conditioning
• E.g. alcohol with vomiting ? vomiting negative ?
  drinking negative

43
Summary Medical

• Allows research to be carried out ? animal/twin
  studies
• The fact theyre treated with drugs means the
  cause must be biological

• Treats the symptoms and not the cause
• Cause and effect ? circular arguments (symptoms
  cause condition or condition cause symptoms?)
• Medical label stigmatises them ? used as an
  excuse because it removes responsibility

44
Summary Behavioural

• Allows to treat behaviour, not label the person
• Scientific ? research can be carried out, and can
  be falsified

• Animal experiments are hard to generalize to
  humans
• Treats the symptoms and not the cause
• Symptom substitution ? the real cause will emerge
  later in other forms
• Ethical concerns about reconstructing behaviour
  to fit in with social norms

45
Summary Cognitive

• Lots of scientific research
• Can be tested and retested
• Focuses on the individual
• Problem solving and practical

• Ignores social factors, and may convince people
  that they can think themselves better

Cognitive therapy and behaviour therapy can
combine to make a more effective treatment
46
Summary Psycho-dynamic

• Despite not being proven, it can still work and
  has been proved to be effective in some cases

• Retrospective ? need to look at the past before
  resolving problem so it lacks predictive validity

47
Summary Humanistic

• Too optimistic about human nature
• Too reliant on personal growth ? some people with
  depression appear to have everything they want
  but are still unhappy ? too materialistic
• Not scientific
• Not empirically testable ? cannot observe things
  like self-actualisation

48
Summary Social

• Helps people live better together
• Combines with medication to help solve problems ?
  needs social skills to integrate

• Very difficult to get trained professionals ?
  expensive
• Families can be a part of the problem!

49
Effectiveness of Therapies

• Judged on
• Observation of behaviour
• Recidivism how often people have to go back for
  treatment
• Self-report
• Meta-analysis look at other research to find a
  trend
• Smith (1980) found that all therapies worked, but
  May found that chemotherapy works the best.
• Its found that experienced therapists are better
  than less experienced therapists ? the therapies
  must help
• This is because experienced therapists adopt a
  multi-model approach bio psychosocial
• People who arent qualified, yet have good
  personal skills can be just as effective ?
  psycho-therapies (talking) are merely placebo

50
Clinical Conditions

• Schizophrenia
• The fragmentation of personality not different
  personalities
• 5 types
• Disorganized Schizophrenia
• Speech/behaviour is disorganized
• Neologisms made-up words
• Word salad mixed-up words in sentences
• Thought-blocking
• Personal hygiene affected
• Catatonic Schizophrenia
• Alternating between high excitement and immovable
  state (catatonic state) ? one of these states
  may dominate
• Inappropriate emotional responses
• Flattening affect (bluntening of emotion)
• waxy movement 0 can move a limb and it would
  stay there

51
Clinical Conditions

• Schizophrenia
• Paranoid Schizophrenia
• Hallucinations
• Delusional thinking (of grandiose, prowess etc)
• Not disorganized
• Undifferentiated schizophrenia
• Patient has symptoms from all forms of
  schizophrenia
• Not clearly categorized
• Residual Schizophrenia
• Some signs still remain, but not overtly
  schizophrenic
• Reliability
• Hard to categorize people with all the different
  symptoms
• Harder to have predictive validity ? prognosis
  would be different for sub-types, and the patient
  may show signs of more than one type

52
Clinical Conditions

• Schizophrenia
• There is another method of classification
• Positive Schizophrenia
• When things are added to the personality e.g.
  delusions
• Associated with dopamine receptors
• Negative schizophrenia
• When things are taken away e.g. flattened
  emotions
• Associated with structural abnormalities of the
  brain (bigger ventricles)
• Positive schizophrenia can also be sub-divided
• Delusions and hallucinations
• Disorganized behaviour

53
Clinical Conditions

• Schizophrenia
• Causes Biological
• Genetic Causes
• Family Studies
• Children of 2 schizophrenic parents have 46
  chance of inheriting schizophrenia
• This may also be due to environmental learning
• Twin Studies
• Gottesman (1991) believed MZ twins had 48
  concordance, whereas this is only 17 in DZ twins
  (concordance relates to both twins getting the
  disorder)
• However, identical twins also share very similar
  environments
• Biological Causes
• Chemicals
• One theory is that dopamine is over-active in the
  synapses, which may explain type one positive
  symptoms of schizophrenia
• Symptoms of acute paranoid schizophrenia are
  similar to those of amphetamine psychosis, which
  is caused by amphetamines over stimulating
  dopamine receptors
• Anti-schizophrenic drugs (e.g. chlorpromazine)
  work by blocking post-synaptic receptors sites
  for dopamine, reducing its activity.
• Post-mortems and PET scans have found more
  dopamine and dopamine receptor sites in
  schizophrenics
• However, the dopamine hypothesis may be an
  over-simplified account of schizophrenia new
  schizophrenia drugs work by affecting other
  neurotransmitters, like Serotonin

54
Clinical Conditions

• Schizophrenia
• Causes Biological
• Biological Causes
• Brain structural causes
• Enlarged ventricles are fluid filled cavities in
  the brain. Reserch has found that these are
  larger in schizophrenics due to brain cell loss.
  Cell loss in the temporal lobes of the brain
  (cognitive and emotional functions) have been
  associated with negative symptoms. However, this
  may be a symptom, and not a cause
• Brain area activity is also found to be different
  for schizophrenics. When given problem solving
  activities, schizophrenics brain scans have shown
  unusual prefrontal activation of the cortex.
  This method cannot yet predict the presence of
  schizophrenia.

55
Clinical Conditions

• Schizophrenia
• Causes Psychological
• Psychodynamic
• Freud argued that schizophrenia could be due to
  regression to a state of narcissism in the early
  oral stage, where no ego is developed to test
  reality. Psychotic thoughts are similar to those
  irrational thoughts first presented by the id.
  Psycho-analysis would not help treat this
  condition because a patient in psychosis does not
  have the necessary attachment to reality.
• Existential
• The idea that people withdraw from reality as a
  response to the pressures of life becoming
  unbearable (Laing)
• Some psychiatrists believe that this can be a
  positive journey of self-discovery
• Labelling theory
• Scheff (1966) argues that schizophrenia, once
  diagnosed, becomes a self-fulfilling prophecy.
• The reactions of other people in society become
  internalised, and help reinforce the idea
• Szasz takes this idea further, and believes we
  create the label schizophrenia to control people
  who are different as a form of social control
• Cognitive theory
• Frith (1979) believed that there was problems
  with short-term memory and the brains capacity
  for information with schizophrenics. An
  attentional-filter mechanism in the brain means
  that information going into the brain overloads
  sufferers from schizophrenia, causing the
  cognitive distractibility

56
Clinical Conditions

• Schizophrenia
• Causes psychological
• Social factors
• Family stresses
• Reichmann proposed the idea of a
  schizophrenogenic mother who can aggravate
  symptoms of schizophrenia
• Also, in families where the is a high amount of
  expressed emotion, symptoms seem to develop more
  frequently in people prone to schizophrenia
• However, this research is correlational, so
  perhaps the schizophrenia causes the stress and
  not vice versa
• Environmental stresses
• Schizophrenia is found to be 8x more likely in
  families of a lower social-economic status
• However, this could be a cause, or an effect of
  the social drift with people with schizophrenia
• Viruses
• Viruses may also trigger schizophrenia (e.g.
  influenza)
• This can be particularly important during the
  pregnancy, when there can be damage to the
  placenta

57
Clinical Conditions

• Depression
• Unipolar depression has a prevalence rate of 5,
  and occurs twice as often in men as in women
• It can be affected by age, gender, social class
  and marital status
• Symptoms Unipolar
• Emotional
• intense feelings of sadness or guilt
• lack of enjoyment of pleasure in things
  previously enjoyed
• Cognitive
• frequent negative thoughts
• faulty attribution of blame (blaming themselves)
• Motivational
• passivity
• difficulty in making and initiating decisions
• Somatic
• Loss of energy or restlessness
• disturbance of appetite, weight and sleep

58
Clinical Conditions

• Depression
• Bipolar depression is less common as Unipolar
• It involves the symptoms of Unipolar depression,
  combined with mania or hypomania
• There is around a 1 prevalence of bipolar
  disorder
• Symptoms Bipolar
• Emotional
• Abnormally euphoric elevated or irritable mood
• increased pleasure in activities

59
Clinical Conditions

• Depression
• Symptoms (Bipolar)
• Motivational
• increase in goal-directed activity
• increase in pleasurable activities with a high
  risk of danger
• Cognitive
• inflated self-esteem or grandiose
• racing ideas and thoughts
• distractib