mh approaches

8/18/2019 Mh Approaches

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Mental Health and Illness

Overview of Approaches, Definitions,Overview of Approaches, Definitions,

PerspectivesPerspectives


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Continuous or discrete?

Continuous model:Continuous model:

Mental Health Mental IllnessMental Health Mental Illness

Health!""""Ad#ustment reaction""""$eurosis""""Ps!chosisHealth!""""Ad#ustment reaction""""$eurosis""""Ps!chosis

%e all have differin& de&rees of mental health at different%e all have differin& de&rees of mental health at different

times in our lives' Most people aren(t at the e)tremestimes in our lives' Most people aren(t at the e)tremes *ut fall somewhere in the middle' *ut fall somewhere in the middle'

An!one can *ecome mentall! ill, &iven the ri&htAn!one can *ecome mentall! ill, &iven the ri&htcircumstances'circumstances'


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Discrete model ome people are mentall! health!- othersome people are mentall! health!- others

have specific mental disorders'have specific mental disorders'

..Decision trees/ can distin&uish who has aDecision trees/ can distin&uish who has a

specific mental disease and who doesn(t'specific mental disease and who doesn(t'

Mentall!

Health!Mentall! Ill


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%hat is mental health?

In our societ!, a mentall! health! person:In our societ!, a mentall! health! person:

Has self1esteem, self1acceptanceHas self1esteem, self1acceptance

Is realiin& potentialIs realiin& potential

Is a*le to maintain fulfillin& relationshipsIs a*le to maintain fulfillin& relationships

Has a sense of ps!cholo&ical well1*ein&Has a sense of ps!cholo&ical well1*ein&

Has sense of autonom!Has sense of autonom!

Has sense of competence, master!, purposeHas sense of competence, master!, purpose

However, other cultures ma! have different ideas a*out whatHowever, other cultures ma! have different ideas a*out whatmental health is'mental health is'


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%ho has mental health?

%e all fall short to some e)tent'%e all fall short to some e)tent'

4herefore, advocates of mental health4herefore, advocates of mental health

*elieve that a *road ran&e of mental health *elieve that a *road ran&e of mental health

services should *e availa*le to &eneralservices should *e availa*le to &eneral

population, not #ust seriousl! mentall! ill' population, not #ust seriousl! mentall! ill'

4he! *elieve that prevention and education,4he! *elieve that prevention and education,as well as treatment, are important'as well as treatment, are important'


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%hat is mental illness?

Is it a disease, li6e dia*etes or smallpo)?Is it a disease, li6e dia*etes or smallpo)?

Is it a form of deviant *ehavior7li6e *ein&Is it a form of deviant *ehavior7li6e *ein&

re*ellious, choosin& to dress differentl!,re*ellious, choosin& to dress differentl!,

*ein& e)tremel! reli&ious, *ein& e)tremel! *ein& e)tremel! reli&ious, *ein& e)tremel!

creative?creative?


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4he Medical Model and

Concepts of Disease ..%hen distress or inappropriate *ehavior is thou&ht to%hen distress or inappropriate *ehavior is thou&ht to

*e a conse9uence of a *odil! d!sfunction, it is called a *e a conse9uence of a *odil! d!sfunction, it is called adisease'(/disease'(/ Mechanic, p' ;0'Mechanic, p' ;0'

4o dia&nose diseases in ph!sical medicine, doctors4o dia&nose diseases in ph!sical medicine, doctors perform la*orator! tests, do *od! ima&in&, ta6e perform la*orator! tests, do *od! ima&in&, ta6emedical histor!, do ph!sical e)aminations'medical histor!, do ph!sical e)aminations'

Once disease is dia&nosed, doctor &enerall! 6nows:Once disease is dia&nosed, doctor &enerall! 6nows: Its causeIts cause How disease is li6el! to run its courseHow disease is li6el! to run its course %hat most appropriate treatment is%hat most appropriate treatment is


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Are mental illnesses li6e other

diseases? Mental illnesses cannot *e confirmed *! o*#ectiveMental illnesses cannot *e confirmed *! o*#ective

la*orator! tests or *od! ima&in&'la*orator! tests or *od! ima&in&'

Dia&nosis in mental illness does not lead to anDia&nosis in mental illness does not lead to anunderstandin& of cause, of the course of theunderstandin& of cause, of the course of the

illness, or of the most appropriate treatment'illness, or of the most appropriate treatment'

ome =e'&', 4homas as> have ar&ued thatome =e'&', 4homas as> have ar&ued that

mental illnesses are not diseases *ecause of themental illnesses are not diseases *ecause of the

a*ove pro*lems'a*ove pro*lems'


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Perspective of DM Mental disorders represent a .clinicall! si&nificantMental disorders represent a .clinicall! si&nificant

*ehavioral or ps!cholo&ical s!ndrome or pattern *ehavioral or ps!cholo&ical s!ndrome or pattern

that occurs in an individual and that is associatedthat occurs in an individual and that is associated

with present distress =e'&', a painful s!mptom> orwith present distress =e'&', a painful s!mptom> ordisa*ilit!'/disa*ilit!'/

DM tries to ma6e ps!chiatric dia&noses moreDM tries to ma6e ps!chiatric dia&noses more

similar to medical dia&noses' ees ps!chiatricsimilar to medical dia&noses' ees ps!chiatric

s!mptoms as indicators of disease, not deviance's!mptoms as indicators of disease, not deviance'


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DM

tren&th: useful tool for practitioners, insurers,tren&th: useful tool for practitioners, insurers,

courts, a&encies, since it allows forcourts, a&encies, since it allows for

communication, offers consistent set ofcommunication, offers consistent set ofdefinitions'definitions'

imitation: However, it is purel! descriptive,imitation: However, it is purel! descriptive,

doesn(t indicate causes, offers limited informationdoesn(t indicate causes, offers limited information

a*out e)pected course of the disease, doesn(ta*out e)pected course of the disease, doesn(tsu&&est appropriate treatment'su&&est appropriate treatment'


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Ma#or DM1IB cate&ories Disorders usuall! firstDisorders usuall! first

dia&nosed in infanc!,dia&nosed in infanc!,childhood, or adolescencechildhood, or adolescence

Delirium, dementia, amnestic,Delirium, dementia, amnestic,

and other co&nitive disordersand other co&nitive disorders

Mental disorders due to aMental disorders due to a&eneral medical condition not&eneral medical condition notelsewhere classifiedelsewhere classified

u*stance1related disordersu*stance1related disorders

chiophrenia and otherchiophrenia and other ps!chotic disorders ps!chotic disorders

Mood disordersMood disorders

An)iet! disordersAn)iet! disorders

omatoform disordersomatoform disorders

actitious disordersactitious disorders

Dissociative disordersDissociative disorders

e)ual and &ender identit! disorderse)ual and &ender identit! disorders

atin& disordersatin& disorders leep disordersleep disorders

Impulse1control disorders notImpulse1control disorders notelsewhere classifiedelsewhere classified

Ad#ustment disordersAd#ustment disorders

Personalit! disordersPersonalit! disorders

Other conditions that ma! *e theOther conditions that ma! *e thefocus of clinical attentionfocus of clinical attention


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ociolo&ical perspective

Mental disorders are t!pe of deviantMental disorders are t!pe of deviant *ehavior, not a disease process' *ehavior, not a disease process'

4hose who are seen as mentall! ill are those4hose who are seen as mentall! ill are thosewho violate social rules, don(t *ehavewho violate social rules, don(t *ehaveappropriatel!'appropriatel!'

Individuals who *ecome la*eled asIndividuals who *ecome la*eled asmentall! ill are those not powerful enou&hmentall! ill are those not powerful enou&hto resist such la*els'to resist such la*els'


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Mental illness as deviant

*ehavior Eesearchers who view mental illness as deviantEesearchers who view mental illness as deviant

*ehavior usuall! stud! processes and rules used to *ehavior usuall! stud! processes and rules used todefine mental illness rather than s!mptoms indefine mental illness rather than s!mptoms inindividuals'individuals'

as =;5+, ;:as =;5+, ;: Mental illness is not a disease, since there areMental illness is not a disease, since there are

no ph!sical lesions that indicate it'no ph!sical lesions that indicate it' Callin& people mentall! ill denies concepts ofCallin& people mentall! ill denies concepts of

free will and responsi*ilit! for one(s actions'free will and responsi*ilit! for one(s actions'


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Assumptions *ehind .*ad/ or

.mad/Am*ivalent ideas:Am*ivalent ideas:

ocial and *ehavioral sciences are deterministic,ocial and *ehavioral sciences are deterministic,

assumin& that *ehavior is determined7*! priorassumin& that *ehavior is determined7*! priorevents, social forces, *iolo&!events, social forces, *iolo&!

At the same time, we assume that individuals canAt the same time, we assume that individuals can

distin&uish *etween ri&ht and wron& and havedistin&uish *etween ri&ht and wron& and have

.free will/ and thus can *e held responsi*le for.free will/ and thus can *e held responsi*le for

their actions'their actions'


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Definitions and la*elin& can *e

pro*lematic $ot so much in voluntar! treatment7if an $ot so much in voluntar! treatment7if an

individual see6s help from a mental healthindividual see6s help from a mental health

professional, then common &oals can *e professional, then common &oals can *eidentified and pursued'identified and pursued'

If an individual is forced into treatment,If an individual is forced into treatment,

then man! ethical dilemmas can arise'then man! ethical dilemmas can arise'


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How can mental illness *e

measured? ome researchers =sociolo&ists, pu*licome researchers =sociolo&ists, pu*lic

health specialists, social wor6ers> prefer tohealth specialists, social wor6ers> prefer to

stud! how mental illness develops instud! how mental illness develops incommunities, rather than its manifestationscommunities, rather than its manifestations

in those who are *ein& treated for mentalin those who are *ein& treated for mental

illness'illness'


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4erms useful in assessment of

mental illness in communities: Epidemiology Epidemiology: stud! of how illness is distri*uted: stud! of how illness is distri*uted

in a population, rates of disease, who appears to *ein a population, rates of disease, who appears to *e

suscepti*le, in an attempt to identif! causes andsuscepti*le, in an attempt to identif! causes anddiscover interventions =e)ample of wor6 of Gohndiscover interventions =e)ample of wor6 of Gohn

now on cholera in ondon in ;now on cholera in ondon in ;

Morbidity Morbidity: prevalence of diseases in a population: prevalence of diseases in a population

ComorbidityComorbidity: occurrence of more than one disease: occurrence of more than one disease

in the same individualin the same individual


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4erms =continued>:

Prevalence Prevalence: How often the disease occurs: How often the disease occurs Point prevalence Point prevalence: percenta&e of: percenta&e of

population affected with an illness at an! population affected with an illness at an!&iven point in time&iven point in time

Lifetime prevalence Lifetime prevalence: percenta&e of: percenta&e of

population ever affected with an illness population ever affected with an illness Incidence: Incidence: rate at which new casesrate at which new cases

appear within a &iven time periodappear within a &iven time period


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pidemiolo&ical studies of

mental illness ;;stst in A: pidemiolo&ic Catchment Areain A: pidemiolo&ic Catchment Area

=CA>, ;, ; ;@(s=$C> ;@(s

Also a num*er of studies of prevalence andAlso a num*er of studies of prevalence and

t!pes of mental illness in other culturest!pes of mental illness in other cultures


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Cross1cultural studies

%hat is normal in one culture is not%hat is normal in one culture is not

necessaril! normal in another necessaril! normal in another

4herefore, measurement in cross1cultural4herefore, measurement in cross1culturalstudies is a real pro*lemstudies is a real pro*lem

4his holds true in cross1national studies and4his holds true in cross1national studies and

in studies of diverse ethnic &roups withinin studies of diverse ethnic &roups withinnationsnations


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%hat causes mental illness?

$o one reall! 6nows' Eesearch so far is $o one reall! 6nows' Eesearch so far is

inconclusive'inconclusive'

Eesearch is *ein& carried out from diverseEesearch is *ein& carried out from diverse perspectives: perspectives:

Ps!cholo&icalPs!cholo&ical

Fiolo&icalFiolo&ical

ociolo&icalociolo&ical


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Fiolo&ical, developmental, or

social? ince human *ein&s are *oth *iolo&ical andince human *ein&s are *oth *iolo&ical and

social animals, it doesn(t ma6e sense tosocial animals, it doesn(t ma6e sense to

ar&ue a*out what causes mental illness'ar&ue a*out what causes mental illness' Causes are comple), involvin& someCauses are comple), involvin& some

com*ination of *iolo&ical vulnera*ilit!,com*ination of *iolo&ical vulnera*ilit!,

environmental conditions, social stressors,environmental conditions, social stressors,social networ6 and supports, ps!cholo&icalsocial networ6 and supports, ps!cholo&ical

orientations, and learned *ehavior'orientations, and learned *ehavior'


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Possi*le ps!cholo&ical

developmental causation: Ps!cholo&ical research into causes of mental illness e)aminesPs!cholo&ical research into causes of mental illness e)amines

individual personalit! =earl! development, co&nitive st!les,individual personalit! =earl! development, co&nitive st!les, personal identit!> personal identit!>

PerspectivesPerspectives Ps!choanal!tical7earl! developmental influences, such asPs!choanal!tical7earl! developmental influences, such as

child a*usene&lect, 9ualit! of parentin&child a*usene&lect, 9ualit! of parentin& Co&nitive1*ehavioral*ehavioral7how wa!s of thin6in&Co&nitive1*ehavioral*ehavioral7how wa!s of thin6in&

affect *ehavior, social learnin&affect *ehavior, social learnin&

Phenomenolo&icale)istential7focus on choice,Phenomenolo&icale)istential7focus on choice,responsi*ilit!, meanin&responsi*ilit!, meanin&

amil! d!namics7focus on famil! roles, communicationamil! d!namics7focus on famil! roles, communication patterns patterns


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Possi*le *iolo&ical causation:

actors e)amined *! researchers:actors e)amined *! researchers:

JeneticsJenetics

$eurochemist! $eurochemist!

Biral causationBiral causation


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Possi*le environmentalsocial

causation:actors e)amined *! researchers:actors e)amined *! researchers:

Chronic strains in the environmentChronic strains in the environment Povert!Povert! Poor livin& conditionsPoor livin& conditions Dan&erous nei&h*orhoodsDan&erous nei&h*orhoods Overwhelmin& role responsi*ilitiesOverwhelmin& role responsi*ilities

$e&ative life events7stress and copin& $e&ative life events7stress and copin& $atural disasters $atural disasters nemplo!mentnemplo!ment Ad#ustin& to new environments and rolesAd#ustin& to new environments and roles


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nvironmentalsocial causation

=continued>:Another factor e)amined *! researchers:Another factor e)amined *! researchers:

a*elin&a*elin&

ocial control7how mental health dia&nosisocial control7how mental health dia&nosisand treatment acts as an a&ent of social controland treatment acts as an a&ent of social control

Eelationship *etween social attitudes towardEelationship *etween social attitudes toward

mental illness and the course of mentalmental illness and the course of mental

disorders7effects of sti&ma, discrimination,disorders7effects of sti&ma, discrimination,

and social e)clusionand social e)clusion


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nvironmentalsocial causation

=continued>:Collective mo*iliationCollective mo*iliation

$otion that societ! produces disa*ilities *! how it: $otion that societ! produces disa*ilities *! how it:

Defines persons with impairmentsDefines persons with impairments

imits access to communit! facilities andimits access to communit! facilities andemplo!mentemplo!ment

Discriminates a&ainst themDiscriminates a&ainst them

Impairments can *ecome either a ma#or aspect orImpairments can *ecome either a ma#or aspect orminor aspect of a person(s identit!, dependin& on howminor aspect of a person(s identit!, dependin& on howsociet! and &overnment respond to persons withsociet! and &overnment respond to persons withimpairmentsimpairments


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Disease or pro*lem in livin&?

ome pro*lematic *ehaviors are &iven the statusome pro*lematic *ehaviors are &iven the status

of disease in DM:of disease in DM:

Alcohol a*use and dependenceAlcohol a*use and dependence Dru& a*useDru& a*use

Conduct disorders in childrenConduct disorders in children

4he! ma! not reall! fit into the disease model4he! ma! not reall! fit into the disease model It ma! *e more valid to consider them as pro*lemsIt ma! *e more valid to consider them as pro*lems

in livin&in livin&


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Pu*lic definitions of mental

illness Most people who see6 treatment for mentalMost people who see6 treatment for mental

disorders do so *ecause the! feel distressed'disorders do so *ecause the! feel distressed'

ome people, however, feel the! do notome people, however, feel the! do notneed help *ut are identified *! others =e'&',need help *ut are identified *! others =e'&',

famil!, friends, police, schools, emplo!ers>'famil!, friends, police, schools, emplo!ers>'

valuators have to ma6e difficult #ud&mentsvaluators have to ma6e difficult #ud&mentsin such cases'in such cases'


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Eole of values

Balues of evaluator can influence #ud&mentsBalues of evaluator can influence #ud&mentsa*out individuals *ein& evaluated'a*out individuals *ein& evaluated'

valuators( notions of what is appropriatevaluators( notions of what is appropriate *ehavior are shaped *! their culture and *ehavior are shaped *! their culture andsocial conte)t'social conte)t'

If an evaluator accepts the worldview ofIf an evaluator accepts the worldview of

hisher societ!, then people with differenthisher societ!, then people with differentworldviews can *e seen as deviant7mad orworldviews can *e seen as deviant7mad or

*ad' *ad'


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Balue of the disease model

Disease model attempts to *e o*#ective andDisease model attempts to *e o*#ective and

universal, avoidin& value #ud&ments a*outuniversal, avoidin& value #ud&ments a*out

*ehaviors' *ehaviors' Ps!chiatrists attempt to separate outPs!chiatrists attempt to separate out

s!mptoms from cultural content =e'&',s!mptoms from cultural content =e'&',

schiophrenia>'schiophrenia>'


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DM Decision 4ree: Mood Disorders

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