Week Two Notes
Popular in Exploring Mental Health and Distress in the Clinic and Community
Popular in Psychology (PSYC)
This 12 page Class Notes was uploaded by Brittany Lopez on Sunday October 16, 2016. The Class Notes belongs to Psy 7 EMC at LSBU taught by Dr Zoë Boden in Fall 2016. Since its upload, it has received 2 views. For similar materials see Exploring Mental Health and Distress in the Clinic and Community in Psychology (PSYC) at LSBU.
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Date Created: 10/16/16
Psychology, Mental Health and Distress Week 2 Medical and Psychiatric Diagnosis o Purposes of diagnosis in medicine Indicate correct treatment Enable predictions about outcome Provide basis for research Indicate probable aetiology Facilitate professional communication Info. And relief for patients and carers Give patients and carers access to service etc. o In order to differentiate medical and psychiatric diagnosis we must: Clarify what we mean by medical diagnosis Understand how medical and psychiatric diagnosis differ Identify problems with psychiatric diagnosis: reliability, validity and co-morbidity Place psychiatric diagnosis in cross-cultural context Consider extent to which psychiatric diagnosis is a social judgement Discuss service user experiences o Symptoms Largely subjective Typically associated with range of conditions Ex. Headache o Signs Objectively identifiable Associated with few conditions Ex. Sugar in urine o Researcher haven't found any signs to confirm or disconfirm functional psychiatric disorders o DSM and ICD consist of only lists of subjective complaints (symptoms) o These symptoms aren't complaints about bodily function (e.g. pain, nausea, thirst) o They're ex. Of beliefs, experiences and behaviors o There aren't measurable, universally agreed standards for deciding on normal ways of feeling, thinking and behaving o Context and culture are always relevant At what point does poor self-care become a medical problem? How flat must affect be in order to be a symptom? At what point do beliefs become delusions? o Who decided and on what basis? Reliability o A measure of the consistencies of judgement: in psychiatry usually tested by comparing diagnosis of different psychiatrists o Studies have produced very mixed results despite Great efforts expended in making DSM reliable Special training for study participants Use of videos, vignettes and other 'stable'/'typical' presentations Co-morbidity o Extent to which people with one diagnosis also meet criteria for another o USA National Co-morbidity Survey (Kessler et al 2005) Over 50% people with diagnosis meet criteria for at least one other 23% could be assigned 3 or more diagnoses o Some people with same diagnosis may actually have no symptoms in common Validity o Extent to which diagnoses reflect naturally occurring disease entities o Predictive validity of psychiatric diagnoses is variable with respect to Outcome Course Duration Treatment efficacy Cross-Cultural Issues o Subjective judgements about 'symptoms' are necessarily bound up with cultural norms o African-Caribbean's in UK up to 12x more likely to be given schizophrenic diagnosis than white people Relative distance from dominant cultural norms? Misinterpretation of reasonable responses to racism as 'paranoia'? o Non-Western cultures that don't separate mind from body may see 'symptoms' in spiritual, religious, philosophical or ethical terms o DSM has special category of 'culture-bound disorders' Implies Western psychiatric diagnosis is NOT influenced by culture Consequences for Service Users o Benefits Comfort and reassurance Access to services Sense of community o Cons Stigma Discrimination and social exclusion 'sick role' Loss of personal meaning o Many of the benefits of psychiatric diagnosis depend on it being valid and reliable o Many of these benefits could be supplied without psychiatric diagnosis Voice-hearing can be explained in non-medical terms, giving comfort and reassurance Voice-hearing can be treated as a psychological problem without having to apply a diagnosis of schizophrenia Formulation o Summarize service user's core problems o Show how difficulties are related by drawing on psychological theories and principles o Suggest, on basis of psychological theory, why client has developed these difficulties, at this time and in these situations o Indicate plan of intervention based in psychological theories and principles already identified o Are open to revision and re-formulation o Limitations Intrinsically subjective Can focus purely on deficits Can be culturally insensitive Can be overly expert-driven o It's relatively easy to address limitations when we don't imagine that we're carrying out an objective judgement o The importance of context/meaning o The person's own interpretation of their life/difficulty o Resilience's and strengths o Provides a hypothesis about person's difficulty o Acknowledging multiplicity e.g. drugs/alcohol and mental distress o Causes and maintenance o Latrogenic causes/maintenance o Dynamic and ongoing How do people view their own distress? o Meaningful o Spiritual o Journey o Illness and pathology o Breaking down o Relationships o Inequalities 'There is no homogenous script' Cognitive behavioral therapy-formulation o People are locked into unhelpful ways of thinking-distorted thoughts, biases o Evidence finding with client o Current problems and solutions (not past) o It ain't what you do it's the way that you do it o Not event themselves but person's explanation and reaction Core beliefs about self (formed in environment) Behaviors and emotions that follow thoughts (e.g. withdrawal, worry) Quality of events-their significance to person's life view Systematic approaches o Individual's problem is symptomatic of wider family struggles/dynamics? o How has family attempted to overcome problems o How are family members communicating? o Power dynamics o Individual is not the only focus-attachments/communication o Problem is dispersed (to wider familial dynamics) o How do family members see individual with problem and each other? How is the problem maintained? Social Constructionism o Interest in time, culture and context-problems can never be viewed outside o Different constructions have varying levels of social power (e.g. He is schizophrenic) Narrative Therapy o Showing people what options they have available to them by allowing them to tell different stories Telling A Different Story o Externalizing (problem is the problem and not the person) o Feelings and their dynamic origins (family, culture, religion, etc.) o History of the problem; effects of the problem and deconstruction o Resistance o Solutions and new stories The Actual Experience of Therapy By Service Users o Therapeutic relationship, not the technique (Elliot & Williams, 2003) o Sense of control over therapy (Westra et al 2010) o Conceptual consistency with individual's belief (Hall & Marzilier, 2009) Feeling Better or Functioning Better? o Function is measured before each IAPT session o Expectations around outcomes (Baddeley, 2014) o Self-blame and expectations around being 'useful'- the 'ought' self'- 'mild mental' o Not about feeling better bet being better. Roles- good mother, better husband etc. o Being normal-what I should be (morality) Social Inequalities o Well established links between inequalities (discrepancy between high and low social status) and mental health (Warner, 1985; Williams, 1999; DOH, 2003) o Individual feelings, thoughts and perceptions of self are linked to social position-gender, race, class and sexuality o Power(lessness) is a key analytic It's Not All in the Mind… o 'Magical Voluntarism' (Smail, 2004) o Discrimination is real; power inequalities are real; abuse is real o Resistances; respect for chosen coping strategies and connection with others (e.g. music not talk) Identity o Powerlessness o Stigma o Shame o Blame o (Johnstone, 2000) Identity Need Not be Negative o Reclaiming 'mad' and 'bonkers' as a label o Philosophy of shared experiences o Unusual experiences come from life experiences Why Community Psychology? o Psychological interventions, over time, tend to fail In short term, psychological treatments show moderate effect size (about 0.4-0.6) i.e. people tend to feel better with therapy than without it In the long term, these effects dwindle (Paykel et al, 2005) followed up CBT clients after 6 years- no difference in relapse rates to those who didn't receive CBT Also a problem with psychiatry (Bentall, 2009) shows relapse rates are slightly worse now than in the 19th C in the UK. Recovery rates get worse the more psychiatrists there are Overall, have more psychologists, psychiatrists, mental health professionals than ever before, but reported distress continues to rise o Why? o Community psychologists would argue because most psychological treatment doesn't address real problem o Boils down to where we should locate the CAUSES of distress In the individual Faulty cognitions; poor relationship skills; inadequate or inappropriate coping; faulty genes or neurochemistry Or in the world Toxic families; abusive relationship skills; stressful lives; oppressive (racist, sexist) societies; poor housing; lack of money; lack of power o Most psychological and psychiatric treatments target the individual. What does this mean for after the therapy has finished? Core Values of Community Psychology o Contextualizes experience o Active in social change Individual, organization, and society o Working collaboratively with others o Plurality (flexibility) of research and development methods (participatory action research) o More critical community psychological approaches challenge the status quo o Emphasis on strengths & competencies E.g. thinking beyond pathology and medical models Key Concepts: The Ecological Metaphor o Person seen within the context of their environment, as inseparable from environment; we can't understand the person without understanding their context o Highly influential: Kelly: 'Becoming Ecological' Interdependence All parts of the system are inter-related Distribution of resources Communities have unequal distribution of resources, and use and generate new resources differently Adaptation People adapt to the situation in which they live Succession Contexts are constantly changing, not static o Bronfenbrenner's (1979) 5 levels of analysis Individuals Microsystems (families, classrooms, residence halls) Mesosystems Organizations (schools, churches, neighborhood ass.) Communities (geographic locality -small towns, urban areas, etc. Macro systems (the societal level) o All of these levels influence each other, and none of them can be understood in isolation Key Concepts: Outsight o David Smail argued for a 'social-materialist' approach to mental distress o 'outsight' vs 'insight' o Argued that psychologists should help clients to develop 'outsight', identifying the structural, material and social conditions which have contributed to their distress E.g. racism, poverty, poor housing o What impact do you think that approach might have? o Why might looking 'out' be more empowering for people than locating their distress as internally caused? o What might be the limitations of this approach? Key Concepts: First and Second Order Change (Watzalwitz, 1974) o First order change: working with the individual to change behavior, thinking, emotions o Second order change: working to change the social and material structures to create a less distressing/more supportive environment o Both aimed at same outcome-improving individual experiences, mental health and wellbeing. Most psychology only works at the level of first order change First Order and Second Order Changes o How might you approach these issues to achieve First order change Second order change o Domestic violence o Shame felt by those in poverty Key Concepts: Power, Participation, and Agency o A key concern of community psychology is considering the role of power in people's experiences, and seeking to improve access to power o Why might power be important in mental health? Less powerful groups have higher levels of mental distress People with less access to decision making have increased levels of distress David Smail argued that all distress came from problematic power relationships Power in the Mental Health System o In the mental health system, there has trad. Been a strong hierarchical power dynamic Treatment doe to people rather than with people Differential power implications Patient-service user-survivor-expert by experience Sectioning and the Mental Health Act o Empowerment is a key aim of many community psychology interventions. Co-production of services; working collaboratively not hierarchically EG: Social Action Psychotherapy Model o White City Project (Sue Holland) West London housing estate-women diagnosed with depression o Four (potential) stages of therapy, moving 'from psychic through social and into political space' 'Patient on pills' Person is seen as individualization and pathologized patient- trade. medical psychiatric approach Person to person psychotherapy Exploring meaning of distress and emotional significance Talking in groups Exploring similarities in experiences with others in similar situations Taking action Identifying the causes of oppression and taking action Community Psychologies o In the USA Separate psychology discipline and professional practice. Often situated within health services. Mixed qual. and quant. Approaches o In the UK Generally a perspective taken by psychology practitioners (e.g. clinical, educational, psychotherapists); links to social psychology; an emerging field o In Latin America Situated in community activism Liberation Psychology o Part of more general tradition in Latin America o Concern with ideology and oppression o Idea that many disciplines aiming to help marginalized people only exacerbate the problem o Role of internalized ideology in perpetuating oppressive systems Idnacio Martin-Baro o Psychologists work from positions of dominance; taking the perspectives of those in power Educational psychologists employed by the school not the community Occupational psychologists work for owners not workers Limits effectiveness, as reinforces rather than reduced marginalization o Assigns "Three urgent tasks" Thinking historically De-ideologising everyday experience Utilizing people's virtues
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