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Week Two Notes

by: Brittany Lopez

Week Two Notes Psy 7 EMC

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Brittany Lopez

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Psychology, Mental Health and Distress
Exploring Mental Health and Distress in the Clinic and Community
Dr Zoë Boden
Class Notes
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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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