What Is Mental Illness
What Is Mental Illness
What Is Mental Illness
Assessment Essay
• 1 Essay, 44% • 44%
• 1 Exam, 44% • Topic
• 12 short responses (weekly), 12 * 1% = 12% – History of psychiatry (4 options)
– Philosophy of psychology (4 options)
• Due Monday May 4, 11.55pm on Blackboard
• Hardcopy due Tuesday May 5, 9am
– HPS office Carslaw 3rd floor
– Or in class on Monday
1
Plagiarism Tutorials
• Just say no • 80% attendance required (university rule) (10
• Presenting the work of someone else as your out of 12)
own • Start in week 2
– Google, cut and paste – Mon 2-4, Carslaw Seminar Room 374
– Paying for essays – Mon 4-6, Eastern Ave Seminar Room 405
– Recycling your own essays submitted for another – Thur 12-2, New Law School 030
Unit of Study – Thur 2-4, New Law School 030
• Plagiarised work receives a mark of “0”, cannot
be made up
History of Psychiatry
• What is it about psychiatry? 01. Why Psychiatry? Why mental
• Why no history of dermatology? Nephrology? illness
• Mental illness? Asylums, Anti-psychiatry and Labelling
– Does it exist?
Theory
– Is it frightening?
– Does it change (and get better)?
– What is normal?
– Is it a disease?
2
Mental Illness
• Psychosis
• Neurosis
I. Mental Illness
• Most attention is given to neurosis ($ spent on
health care)
• Consequences of psychosis are far more serious
Mental Illness
1. What is disease?
1. Suffering (subjective) • Diagnosis based on symptom patterns, not on
2. Decrease of function (inter-subjective) medical tests identifying disease (lesion,
3. Disease process (medical tests)
2. Mental illness microbes, etc.)
1. Mania: not suffering • “Depression is a lack of serotonin in the brain,
2. Disease process often not known
3. Knowledge of context needed just like diabetes is a lack of insulin in the
3. Difficult examples: blood.”
1. Gambling addiction
2. Internet addiction The serotonin blood test does not exist.
3. Footballers behaving badly
4. Mad vs bad
Mental illness is the enigma of modern medicine
• Context important
Mental Illness
• Example: It is necessary:
– Young man, rich, works 12 hours a day • To know the social context (including generally
accepted norms of behaviour, behaviour patterns
before/after)
• To have a model of normal behaviour
• Question: can medicine / science /psychiatry /
psychology tell us what is normal?
• Where does psychiatry get its norms from?
• In what type of society does psychiatry do well?
3
Conclusions
• Mental illness: diagnosis needs to take into
account social and cultural factors (bio-psycho-
social model) II. Society
• The role of psychiatry in society
– Expectations
– Normality
• A framework to analyse psychiatry
– See how far we get.
4
•MAD vs Other Critics: Michel Foucault
History of psychiatry
BAD
The Enlightenment and the
great confinement
• Problem 1960s: how to treat criminals in mental
hospitals Enlightenment: reason
• Problem 2010s: so many prisoners are mentally Do away with “unreason”
ill
Disability in USA
• Unemployment benefits paid by the states
• Disability insurance paid by the federal
II. Money talks government
http://apps.npr.org/unfit-for-work/
5
Disability in Australia
• Wealthy private schools have highest disability
rates
• Why?
– Rating of school depends on exam results
– PTSD: untimed exams better results
– Full-time school counsellors
6
Doing it right: Matthew Newton
• 1. I have been a bad man
• 2. I do confess
– To Oprah, and to everybody
• 3. I am coming clean (…)
• 4. …. ???????
[I have been abused as a child; my mother rejected me;
I only got food when I won a price; I was bullied; I
was beaten; I was an altar boy]
Public confession
No priest, but Oprah; no gospel, but psychiatry
• 2. Explanation model
– Blaming can stop, understanding can start
– It is my brain, not me
• Legal context: diminished responsibility because
of mental illness
– Alien abduction
• Expert witnesses
– Now I understand myself!
• Non-existing diagnosis
• Not in DSM-V • It does not work:
Saminaden, Annick, Stephen Loughnan, and Nick Haslam.
“Afterimages of Savages: Implicit Associations between
‘Primitives’, Animals and Children.” British Journal of Social
Psychology 49, no. 1 (2010): 91-105.
• Yet …
7
• 3. Identity model
– Asperger’s syndrome no longer exists
– In US, >90% of individuals with Asperger’s are self- • 4. Compensation
diagnosed – I fought in Afghanistan
– Asperger internet forums
Psychiatry
• Social control, regulating deviance
• Money talks
– Disability IV. Asylums
• Attractive to individuals
– Avoiding blame and punishment
– Understanding
– Identity
The start of psychiatry: physicians were
– Compensation
invited to asylums (later: mental hospitals)
What does this have to do with psychiatry?
Before 1970: mental hospital was hallmark of
psychiatry
1. Rosenhan
David Rosenhan, “On 1. Psychiatrists can be fooled
being sane in insane 2. Labels are sticky
places.” 1972 3. The Mental Hospital is not a good place to be:
It maintains an (arbitrary) diagnosis, rather
than helping underlying distress.
8
2. The experiment repeated
Lauren Slater, Opening
The Experiment Repeated: Pandora’s box,
Robin Winkler, 2004
Australian Radical
Psychologist
UNSW, (1973)
3. Asylums
1. Psychiatrists can still be fooled • Ervin Goffman
2. Diagnostic Fashions Change - PTSD replaces – If you are not insane when you enter an asylum, you
Schizophrenia will when you stay there
– Total institutions
3. Drugs are main treatment resource
– Examples:
4. It is now virtually impossible to get admitted • Auschwitz
- “revolving door treatment” • Prisons
• Military training camps
• Mental hospitals
Conclusions
• The nature of mental illness: the enigma of medicine
• 1970s: deinstitutionalisation – Biological, social, psychological, cultural
• No more asylums • The critics: Psychiatry in society: adjusting individuals
• Mental hospital as problem
• Mental illness
• Problem solved?
– Physicians
– Pharmaceutical companies
• Not really – Patients/consumers
– Schools
– Mental illness, homelessness
– Etc.
– More than medication needed
• Placing psychiatry in context