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Date Created: 01/30/15
January 27 2015 Szasz is opposed to the tendency of some to automatically treat people who behave in morally bad ways as mentally ill Ex someone who commits murder should not automatically be regarded as mentally ill the person simply act badly Take some sort of action and pathologize them make these actions into a disease Szasz does not agree with this quickness to diagnose On the ip side if alcoholism is a disease you cannot blame them for the characteristics that are associated cannot hold them responsible Szasz thinks in many cases that this is unfortunate and troubling A view that underlies Szasz s Physical illnesses involve some departure from some clearly defined biological norm or a biological dysfunction These are largely objective In contrast when a patient is said to have a mental illness the norm form which he or she departs is typically social or moral and this makes the diagnosis of mental illness a much more subjective matter 0 The matter is now the therapists opinion An example specific to Szasz According to DSM a diagnosis of major depression episode requires that a patient suffering from depression must satisfy five of the following criteria However there is one exception 0 The grief exception if you feel depression up to 2 months after the death of a loved one this does not qualify for depression Several features stand out 0 Why just five Why not four or six 0 If you are going to make an exception why not make exceptions for other major set backs in life ex loss of job physical injury 0 Points out there is a certain level of arbitrariness 0 Some sort of value judgment going on here Now the grief exception has been dropped by the DSM o This seems to highlight the arbitrariness of the grief exception what was the principle basis for this 0 There seems to be a considerable amount of subjectivity to certain evaluations who is to judge what is a symptom that can qualify I THIS IS THE MAJOR POINT OF SZASZ Concepts of Disease Causes and Symptoms Murphy article Contrast between thinking of disease through the causes vs looking at the symptoms Crux of the matter both in medical practice and to common sense we think of disease in casual stance A disease may exhibit a collection of symptoms Example the main symptoms of cholera are diarrhea and vomiting yet the cause is a bacterium in the intestine Understanding the CAUSE of a disease is important if you want to intervene and treat the disease effectively However understanding the symptoms will also help you treat the symptoms but this is different than treating the disease May make the cold less unpleasant but to rid the disease you need to focus on the cause That is why it is practical to classify diseases as their causes rather than just lists of their symptoms want to get rid of the entire disease or sickness not just the symptoms This was not also the case 0 Prior to 19th century the disease were though of mainly long collections of symptoms or as syndromes 0 It was thought that same disease could have many different causes Relatively recent diseases are often due to a single causes that disease should be defined in terms of their causes and that the same causes will be operative in most or all people suffering from the disease Definingclassifying disease in terms of their causes will seem like a good strategy if you have some change of discovering what those causes are However classification of mental illness is still very symptom based 0 Depression do you have suicidal thoughts sleep a lot says nothing about the cause of the disease rather just the symptoms Disadvantages of symptom based classification Will tell little ways to intervene May mix together a number of different underlying conditions hat should be separated and treated separately Example fever cough nausea o Obvious problem is that there are a number of different diseases that could cause this 0 Maybe there is a collection of causes 0 A list of these symptoms does little to treat the underlying cause kind of arbitrary of what to put on the list January 28 2015 A more serious illustration Depression originally thought to be just one disease now can be separated into two 0 Bi polar and non bi polar on the base of differential reaction to medication A second to demonstrate a similar point Schizophrenia is this one disease 0 A number of people have proposed that there is a family of diseases that have some loose resemblance to one another 0 If there are many forms how do you treat or diagnose when confronted with a disease there are potentially two strategies to follow lumping the disease 0 advantage standardized treatment communicate the disease split them apart 0 break down the different disease or types Aronowitz When does a collection of symptoms become a disease Discussion brings out that even some physical diseases have been controversial 0 Should it be characterized mainly in terms of the presence of certain symptoms or in terms of the presence of certain symptoms 0 For example in early 20th century debated whether angina should be defined as a characteristic of pattern chest pain BUT it is also true that when this happens there may be some tendency to think that the condition in question is not a real disease So there is a tendency to think that cause based characteristics when possible are somehow objective or perhaps more scientific Mental illnesses illustrate all of these points Mental illness are in terms of symptoms rather than underlying causes Why Because these underlying causes may be unknown Schizophrenia example DSM presents five symptoms DSM is primarily symptom based Why Basic explanation is twofold 0 Not much is known about the underlying causes of illness and there is sometimes no agreement about the cause 0 The creators want to create a way to characterize a way that there is some sort of agreement on the diagnosis because the symptoms are the same in most cases Operationalist view all there is to schizophrenia is whatever is measured by the various diagnostic criteria for schizophrenia Defined in this way cannot raise the question of whether these criteria are really food ones for diagnosing schizophrenia Realist view contrasts the operationlist view Brain condition that is distinct from the symptoms Here one can raise the question of whether various proposed diagnostic criteria are really reliable indications of schizophrenia