Component 3: Applied Psychology

2. Component 3: Applied Psychology • Issues in Mental Health • Criminal Psychology • Child Psychology • Written paper = 2 hours • 35% of overall A level • 105 marks For each you must be able to …. • Background • Research (and how it links to topic) • Application to situations/case studies • Relevant issues and debates within each topic

3. Throughout component 3 you must be able to refer to any of these debates in detail when it applies Before we begin, you must recap on the debates. • Nature/nurture • Freewill/determinism • Reductionism/holism • Individual/situational explanations • Usefulness of research • Ethical considerations • Conducting socially sensitive research • Psychology as a science • Ethnocentrism • Validity • Reliability • Sampling bias.

4. Section A: Issues in Mental health Topics 1. The historical content of mental health 2. The medical model 3. Alternatives to the medical model

5. Lesson aim To understand how mental illness has been explained and defined historically. Through: • Outlining the key beliefs about the causes of mental illness throughout history • Describing the four key methods of defining abnormality. • Evaluating the key methods of defining abnormality

6. Background: Historical views of mental illness and definitions What is ‘mental health’? • A state of wellbeing

7. Who suffers from mental health issues? • One in four British adults are diagnosed with at least one mental health problem each year • True or false? • True • In the 1950’s it was 1/100!!

8. Who suffers from mental health issues? • Today’s young adults are twiceas likely as their grandparents to experience depression? • False… Young people are three times as likely

9. Who suffers from mental health issues? • 1 in 20 children aged five to 16 have a clinical diagnosed mental disorder • False… it is 1 in 10!!

10. Who suffers from mental health issues? There are more prison inmates with severe mental disorders in prison than there are psychiatric patients in a psychiatric hospital? True! In many instances, all prison inmates are assumed to be suicidal due to the high number of mental health instances in prison populations

11. Who suffers from mental health issues? There is a common misconception that those who suffer from mental health issues are weak. Think of soldiers and what their job entails on a daily basis… they are one of the strongest ‘types’ of people and yet the prevalence amongst soldiers of mental health issues is prominent. QUESTION: Is it only us normal people with ‘real’ problems who suffer?

12. Ben Stiller:Bipolar disorder Who suffers from mental health issues? Martin Lawrence: Depression Jim Carrey: Depression

13. Stormzy: Depression Demi Lovato: Bulimia Mental illness can happen to anyone Robin Williams: Depression Committed suicide Britney Spears:Bipolar disorder

14. STIGMAS?

15. Mental illness vs physical illness

16. Where does this stigma come from? Views on causes of mental illnesses have changed throughout history, depending on the culture or the age in which they occur. LO: To outline the key beliefs about the causes of mental illness throughout history TASK: Create a timeline of ‘Mental Health’ throughout history on A3. Think about society’s attitude towards MH

17. 1550 BC: Ancient Egyptian medical records demonstrated an understanding of depression • Evil spirits were trapped inside individuals and this is what caused mental illnesses • Treatments included spells, exorcisms and trepanation – drilling a hole through skull to allow evil spirits to ‘escape’ • This was used all the way up to the 1800’s, where in treating depression and schizophrenia, they would drill and destroy part of the brain they believed was responsible for this (there is evidence that people actually survived this!)

18. 1550 BC: Ancient Greek physician Hippocrates was the first to theorise that mental health was caused by physical entities. He believed that madness resulted in an imbalance of 4 bodily fluids and could be cured by balancing these. These include: blood, yellow bile, black bile, and phlegm. For example depression was thought to be a result of an excess of black bile and certain diets and laxatives would rebalance this excess.

19. 1300’s-1400’s • Superstition returned. Mentally ill people were possessed by witches and spirits or werewolves • Treatment: exorcism or burning of the witches • Epilepsy was one of the illnesses that were frequently confused with witchcraft or demonic possession and, as these were more prevalent in women, more women were burned as witches than men. • The burning of witches began to fade in the 1500’s due to a greater understanding of epilepsy.

20. 1800’s • Introduction of mental asylums – housing and confining the mentally ill. • Focused on keeping ill people away from society. • Most inmates were institutionalized against their will, lived in filth and chained to walls, and were commonly exhibited to the public for a fee. • Bedlam Asylum • Mental illness was nonetheless as a physical illnesses and therefore treatments such as purges, bleedings, and emetics (a drug that causes vomiting) were used.

21. 1800s • Other treatments included dousing the patient in either hot or ice-cold water to shock their minds back into a normal state. • “Gyrating chair” was intended to shake up the blood and tissues of the body to restore equilibrium, but instead resulted in rendering the patient unconscious without any recorded successes.

22. 1900’s • Mental asylums were seen as poor treatment towards the mentally insane • Psychiatry became a medical specialty • Freud attempted to explain mental illness as a result of the mind, specifically the unconscious mind, introducing ‘talking therapies’

23. 1960’s to present day • Medical model is dominant – mental health is diagnosed and treated according to the biological explanation. • Medication and therapy used to treat MI • Most people able to become productive members of society but many require further care

24. LO: To outline the key beliefs about the causes of mental illness throughout history TASK: Create a timeline of ‘Mental Health’ throughout history on A3. Think about society’s attitude towards MH

25. What is a normal behaviour? • Conformity to the most common behaviour in society • Linked with social norms – what is deemed acceptable in that society • Direct eye contact with the person you are speaking to • Social norm in UK, not in other countries An abnormal behaviour, therefore, is the opposite.

26. Using whiteboards… • List three behaviors that you consider to be an abnormal behavior • Normality = good mental health • Abnormality = poor mental health

27. LO 2. Describing the four key methods of defining abnormality . Rosenhan and Seligman (1984) suggested four definitions which would define abnormality. They did not say that every criteria would necessarily have to be fulfilled. • Statistical Infrequency • Deviation from Social Norms • Failure to Function Adequately • Deviation from Ideal Mental Health

28. One: Statistical infrequency Any behaviour that is shown less often than the normal amount for that society is, by its very nature, abnormal Statistically, 3.45% of the UK population was diagnosed with schizophrenia. Depression is one of the most frequent disorders, but only 7.38% were diagnosed in the UK. It is infrequent enough to be classed as abnormal in this criteria If a behaviour is rare, it is considered abnormal. But how rare is rare?

29. Average IQ in the population is 100pts. The further from 100 you look, the fewer people you find An Example of Statistical Infrequency: IQ frequency 70 100 130 IQ Scores graphics from www.psychlotron.org.uk

30. A very small subset of the population (<2.2%) have an IQ below 70pts. Such people are statistically rare. We regard them as having abnormally low IQs Statistical Infrequency However, highly gifted individuals in sport, art or intelligence may be abnormal however they may not actually have a psychological disorder. frequency 70 100 130 IQ Scores graphics from www.psychlotron.org.uk

31. Two: Deviation from social norms • Social norms are a set of unwritten rules about what behaviours are expected and acceptable within a particular social group • Social norms may or may not be maintained through laws • Society frowns upon those who talk to themselves in the middle of the street. This deviates from social norms and therefore is considered abnormal. However, does this mean they have a mental illness?

32. Two: Deviation from social norms Example: Checking you have locked the front door once or twice is ‘normal’, checking 24 times would be considered excessive (OCD) However, if someone doesn’t abide a social norm, such as getting a job, this doesn’t necessarily indicate a psychological disorder. Therefore, it is difficult to judge someone as abnormal if it is sometimes acceptable to break our social norms.

33. Two: Deviation from social norms We need to think about • The degree to which the norm is violated • The importance of the norm • Is the violation rude, eccentric, abnormal or criminal • Culture • Time • Context

34. Three: Failure to function adequately • If a person is unable to live a normal life adequately – eg hold down a job, maintain a relationship, look after self, interact in society effectively - then they could (under this diagnostic tool) be considered abnormal • It is important this definition does not automatically confer the label of mental illness • Some may lack employment due to poor education, lack of interest may influence poor relationship history etc.

35. Despite this, if person spends all financial resources on alcohol, cannot function properly when drunk/is always drunk, and cannot take care of self, it is fair to say the individual may have a psychological disorder such as addiction

36. Four: Deviation from ideal mental health Ideal mental health • Feeling positive about self and ability to grow psychologically • Self discipline • Ability to act independently • Accurate perception of reality and ability to cope with demands • Positive social interactions with friends and family These do not have to be present at all times Rosenhan 1989 and Johada (1958) both agreed on this

37. Four: Deviation from ideal mental health Poor mental health • Suffering – in some way a person has negative consequences of their behaviour • Maladaptiveness – inability to fit in with society • Unconventional behaviour – something that wouldn’t be expected in society • Irrational behaviours which cannot be understood by others • Unpredictability/loss of control • Violation of moral standards where behaviour fails to meet standards set out by society

38. Four: Deviation from ideal mental health Rosenhan said, ‘normal’ people may display some of the ‘poor mental health’ criteria. Rosenhan’s criteria is vague, difficult to measure and hard to quantify.

39. Learning objective: To understand how mental disorders are categorised and diagnosed. Through: • Look at how the current diagnostic criteria's diagnose

40. What’s the point in a diagnostic criteria? • Introduces a logical process of assessing behavioural criteria as a symptom(s) of a disorder • For physical illnesses, such as a stroke, there are a list of symptoms that are both medical and non-medical to look out for in order to identify a stroke • The same process is used when diagnosing such psychological disorders

41. LO1: How the current diagnostic criteria's diagnose The two main approaches that you need to know about are the… • Diagnostic and Statistical Manual of Mental Disorders (DSM). This is predominately used in the USA • International Classification of Disorders (ICD). This is predominantly used by the rest of the world • Both include a standardised criteria of symptoms and characteristics for each disorder • The DSM and ICD are regularly updated to keep up with changes in society and to make diagnosing as reliable and accurate as possible

42. DSM • DSM is a multi-axial tool, which means that clinicians have to consider if a disorder is from Axis 1 (clinical disorders) and/or Axis 2 (personality disorders) • Then the general medical condition of the patient is considered, plus any social and environmental problems. • This is all used to assess functioning of the person on a scale from 1-100.

43. The DSM and ICD • Both offer a starting point to identify a disorder • However they are not useful for explanations of disorders or treatments • We will look at examples of the DSM and ICD criterion when we look at depression, schizophrenia, and obsessive compulsive disorder

44. Out with the old • In 1986, Homosexuality was removed as a psychological disorder In with the new • Hoarding was previously regarded as a symptom or subtype of Obsessive Compulsive Disorder, but is now considered as a separate, distinct disorder • In 2013, internet gaming disorder was introduced.

45. Is the DSM and ICD really helping those in need? The taskforce • Both are created by a ‘taskforce’ of 15 psychiatrists – predominately white • Small group of elites raises question over the reliability • They vote to see if a disorder should or should not be included (3 hour debate) • Voting lacks a scientific basis, allows for subjective bias Ignores culture • Western dominated • Self-Defeating Personality Disorder (SDPD) symptom is self-sacrifice. this is religious practice in Indian culture • Hearing voices in head warrants diagnosis of schizophrenia, however in Plain Indian tribe = normative experience

46. Is the DSM and ICD really helping those in need? Gender bias • Social stigma encourages males to be “a man” • Females stereotyped to be more in touch with emotions • Can lead to self fulfilling prophecy • Females are twice as likely to be diagnosed with depression than males • Additionally, Ford and Widiger found that presenting the same symptoms to clinical psychologists (but changing the gender) led to a different diagnosis

47. Is the DSM and ICD really helping those in need? Pharmaceutical industry • Davies (2013) there is an association between DSM and ICD with the prescription of psychiatric medication • Krimsky & Cosgrove (2012) 69% of DSM members having links with the pharmaceutical industry • Mojtabai and Olfson (2011) the prescription of antidepressants has tripled in the 20 year period DSM has dominated, earning pharmaceutical industry over 21 billion per year • Sroufe (2012) suggest the misuse of drugs or the diagnosis of something to avoid looking for the ‘real cause’ eg parenting or environment

48. Video illustrating weaknesses of DSM! • http://psychyogi.org/dsm-icd-categorising/

49. The reliability of these diagnostic criterion is even questioned by practitioners Kappa is a measure of the extent of agreement between two clinicians when diagnosing the same patient (similar concept to inter-rater reliability) The measurement ranges from 0 to 1 and considers the same diagnosis being dur to chance 0 = no agreement and 1 = perfect agreement Spitzer & Fleiss (1974) agreement = 0.52 They concluded no category of mental disorder has consistently high reliability – this will be explored further by Rosenhan later in course

50. Evaluation of defining and categorisation of mental issues  Highly subjective – can change from one health professional to the next  Requires self-report from individuals who may not perceive their behaviour as abnormal or dysfunctional, or who may be prone to lying/disordered thoughts and social desirability