basic assumptions 1. external environment leads to mental condition life events, chronic strains,...
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BASIC ASSUMPTIONS
• 1. EXTERNAL ENVIRONMENT LEADS TO MENTAL CONDITION
• LIFE EVENTS, CHRONIC STRAINS, SOCIAL ROLES
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Yearly rates of severe events and depression in six population (Brown 1998).
-45-35-25-15
-55
152535455565758595
Rate
per 100
women
87
3121
118
0
30.0
15.1 10.3 10.6 11.02.4
Zimbabwe London BilbaoOuter Hebrides
Spanishrural
Basquerural
Severe events
Case depression
.
Stressful Life Events and Rates of Depression
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ASSUMPTIONS (CONT.)
• 2. CURRENT ENVIRONMENT MOST IMPORTANT
• 3. GROUPS HAVE DIFFERENT EXPOSURE TO STRESSORS AND RATES OF DISORDER
• 4. FOCUS ON COMMUNITY POPULATIONS NOT CLINICAL CASES
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• 5. DISTRESS IS OFTEN COLLECTIVE AND NOT INDIVIDUAL
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I. DURKHEIM
• SUICIDE (1897)
• SUICIDE RATES VARY SYSTEMATICALLY WITH SOCIAL CONDITIONS
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CAUSES OF SUICIDE
• 1. LACK OF CONNECTION TO SOCIAL GROUPS AND MEANING SYSTEMS - EGOISTIC (ALTRUISTIC)
• 2. LACK OF CONSTRAINT OVER BEHAVIOR – ANOMIC (FATALISTIC)
• FOCUS ON SOCIAL NOT INDIVIDUAL
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II. MILITARY PSYCHIATRY
• LESSONS OF WWI
• HUGE PROPORTION OF PSYCHIATRIC CASUALITIES
• LED TO PRESCREENING OF ALL DRAFTEES IN WWII
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MILITARY PSYCHIATRY
• HUGE PROPORTION OF PSYCHIATRIC CASUALTIES IN WWII
• OVERALL 25%; OVER 70% FOR LONG STRETCHES
• AVERAGE SOLDIER WOULD BREAKDOWN AFTER 80 DAYS OF CONTINUOUS COMBAT
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EFFECT OF COMBAT
• HIGHLY PRESCREENED• NO INDIVIDUAL PREDISPOSITIONS
PREDICTED BREAKDOWNS• WHAT DID?• LENGTH OF COMBAT BEST
PREDICTOR• CAUSE WAS ENVIRONMENTAL NOT
INDIVIDUAL
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EFFECT OF COMBAT
• TREATMENT NEAR UNITS
• 2/3 RETURNED TO UNITS WITHIN 2 DAYS
• MINORITY MORE LASTING PROBLEMS (PTSD)
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MAJOR REORIENTATION
• ENVIRONMENT CAUSE OF MUCH DISORDER - “EVERYONE HAS THEIR BREAKING POINT”
• FOCUS ON ENTIRE POPULATION NOT JUST TREATED CASES
• TREATMENT SHOULD BE IN COMMUNITY NOT HOSPITALS
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III. STRESS THEORY
• AMBIGUITY OF “STRESS”
• HERE: STRESSORS = CAUSES
• DISTRESS = EFFECTS
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HANS SELYE
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HANS SELYE
• PHYSIOLOGIST
• STUDIED STRESS IN ANIMALS
• STRESS RESULTED FROM DISTURBANCES OF EQUILIBRIUM - CHANGE
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SELYE (CONT.)
• ENVIRONMENTAL CAUSES – TEMPERATURE, FOOD, CROWDING
• STRESSORS CAUSE PROBLEMS BY WEAKENING IMMUNE SYSTEM
• GAS - GLOBAL ADAPTATION SYNDROME
• ANY DISTURBANCE OF EQUILIBRIUM CAN LEAD TO GAS
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HOLMES AND RAHE
• MILITARY PSYCHIATRISTS
• TRANSLATE STRESS THEORY AND WWII TO CIVILIANS
• STARTED WITH SAILORS
• MANY OTHER GROUPS
• SRRS IN 1968
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HOLMES AND RAHE SRRS
• STANDARDIZED SCORE
• NEGATIVE - DEATH, DIVORCE, JAIL
• AND POSITIVE - MARRIAGE, HAVE CHILD, XMAS
• BOTH CAN DISTURB EQUILIBRIUM
• FOCUS ON CHANGES
• SUM NUMBER AND GET SCORE
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H+R LIFE EVENTS
• RELATED TO BOTH MENTAL AND PHYSICAL HEALTH (NON-SPECIFIC)
• LESS THAN 150 - FEW HEALTH PROBLEMS
• OVER 300 - 80% HAVE PROBLEMS
• OVERALL MODERATE CORRELATION WITH HEALTH PROBLEMS
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CRITICISMS OF SRRS
• IGNORES CONTEXT AND MEANING
• ONLY NEGATIVE ARE STRESSFUL
• WHAT IS CAUSE AND EFFECT?
• NOT UPDATED
• IGNORES DIVERSITY OF RESPONSES
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GRADE DISTRIBUTION
• 90 – 100 A N = 65
• 88 B+ N = 17
• 80 - 86 B N = 75
• 76 - 78 C+ N = 21
• 60 - 74 C N = 64
• 50 - 58 D N = 11
• 32 - 48 F N = 4
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GRADE DISTRIBUTION
• 90 – 100 A N = 45
• 88 B+ N = 15
• 80 - 86 B N = 69
• 76 - 78 C+ N = 36
• 60 - 74 C N = 65
• 50 - 58 D N = 20
• 32 - 48 F N = 11