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UNIT 4
AREA OF STUDY 2
MENTAL HEALTH
Key Knowledge 1:
Concepts of normality and differentiation of mental health from mental illness
SIX APPROACHES TO NORMALITY & ABNORMALITY
Approach
Explanation
Example
 Identify the appropriate approach that is relevant to each of the following scenarios.
1. Brain biochemistry imbalances can cause depression, yet treatment with drugs is often successful.
_________________________
2. A person is unable to hold down a job due to arachnophobia.
_________________________
3. Wearing pyjamas to school would be considered bizarre, yet it is normal if you wear them to bed.
_________________________
4. Young men often hold hands in Pakistan, an act rarely seen in most parts of Australia.
_________________________
5. Most test results tend to show an obvious central tendency.
_________________________
6. Ancient Greeks considered homosexuality normal.
________________________
DEFINTIONS

Abnormality:

Normality:
 Identify the advantages and disadvantages to the 6 approaches.
Advantages
Disadvantages
 Complete Learning Activity 11.2
HEALTH & ILLNESS

Disease:

Illness:

Health:
MENTAL – appropriate feelings,
rational thinking
SOCIAL – personal relationships
and interactions
PHYSICAL – body e.g. exercise, diet
 Complete Learning Activity 11.4
PAST EXAM QUESTIONS
1. Normal and abnormal behaviours are sometimes differentiated on a statistical basis using
a. a measure of the intensity of the behaviour compared to others in a population
b. a rating scale based on agreed statistical proportions in the population
c. a normal distribution curve to define the bounds of normality
d. clinicians’ assessments of the category the behaviour represents
2. Mental illness is normally indicated when a person
a. acts differently to others
b. is unhappy or acts in a way that is emotionally distressing to self and others
c. has mannerisms that are unusual and may affect their relationship with others
d. acts, thinks and reacts to events in ways that are well beyond the expected responses
3. List and describe three characteristic of mental illness.
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
3 marks
UNIT 4
AREA OF STUDY 2
MENTAL HEALTH
Key Knowledge 1:
Concepts of normality and differentiation of mental health from mental illness
Key Knowledge 3:
Use of biopsychosocial framework (interaction and integration of biological, psychological and social
factors) as an approach to considering physical and mental health
PHYSICAL HEALTH vs. PHYSICAL ILLNESS
Physical Health:
 Body functions efficiently and effectively in work and leisure activities;
 Body is in good condition;
 Body resists disease;
 Body is able to cope in threatening or emergency situations
 Assessed by HR, body temperature, blood pressure, cholesterol etc.
Physical Illness:
 Our subjective experience of a disease or physical health problem;
 Interferes with the normal functioning of our body;
 Negatively impacts on our ability to function effectively in everyday life
MENTAL HEALTH vs. MENTAL ILLNESS
Mental Health:
 Capacity to interact with others and the environment in ways that promote wellbeing;
 Capacity to cope effectively with problems and stress.
 Continuum: Mental Health -----------------Mental Health Problem (acute)-----------------Mental Illness(chronic)
Mental Illness:
 Psychological or behavioural dysfunction
 Usually impairs ability to cope with everyday life and stress
 PSYCHOLOGICAL DYSFUCNTION: breakdown in cognitive, emotional and/or behavioural functioning e.g. fear of
crowds – don’t go to shopping centres
 Complete Activity 11.6 (question 8 and 9)
Physical
Health
1. Enjoying a sense of wellbeing and being optimistic and
emotionally resilient
2. Experiencing a constant, unwanted though that can’t be
controlled and negatively affects your daily functioning
3. Wanting to stop gambling but feeling compelled to
gamble every week
4. Feeling fearful of a situation because you have had a bad
experiencing with it previously, and you are not confident
that you can cope with its demands
5. Being g able to complete all your daily activities free of
pain and discomfort
6. Feeling stressed from the pressures of study by going to
school every day and maintain normal routines
7. Feeling happy and content with your life but unable to
perform daily activities due to pain or discomfort
8. Feeling constantly fearful of a range of situations but not
knowing why
Physical
Illness
Mental
Health
Mental
Illness
BIOPSYCHOSOCIAL FRAMEWORK
 Also called biopsychosocial model/theory
 Biological, psychological and social factors interact to influence a person’s health (both physical and mental)
 Used to diagnose and manage mental illness
 Holistic view: focus on all three factors, not just one or two

Health and illness are best understood by considering specific factors from each domain and how these factors
may interact to influence wellbeing
1. Biological: physiological elements not under our control (e.g. genetics, neurochemistry);
2. Psychological: everything associated with mental processes (e.g. learning, perception, emotions);
3. Social: interaction skills, interpersonal relationships, support systems, cultural factors, education, etc.
E.g. Personality Disorder:
- Biological: inherited genes, impaired brain functioning
- Psychological: poor self-image and intense fear
- Social: strict upbringing and lack of social skills
PAST EXAM QUESTIONS
1. In distinguishing mental health from mental illness it is important to
a. Assess a person’s behaviour in terms of the immediate impact it has on others
b. Consider the social and cultural context of the person and the distress it causes to self and others
c. Establish the exact statistical probability that the behaviour is rate thus likely to be abnormal
d. Define precisely the category into which the behaviour falls to determine abnormality
2. Mental illness is normally indicated when a person
a. Acts differently to others in his immediate peer groups
b. Is unhappy or acts in a way that is emotionally distressing to self and others
c. Acts, thinks and reacts to events in ways that are well beyond the expected responses
d. Has mannerisms that are unusual and may affect their relationship with others
UNIT 4
AREA OF STUDY 2
MENTAL HEALTH
Key Knowledge 2:
Systems of classification of mental conditions and disorders: underlying principles of classification;
strengths and limitations of discrete categorical (DSM-IV and ICD-10) and dimensional (graded and
transitional) approaches to classification of mental disorders
SYSTEMS OF CLASSIFICATION OF MENTAL CONDITIONS & DISORDERS
Two main classifications: categorical and dimensional which are often used together
1)
-
CATEGORICAL
Organises mental disorders into categories, each with specific symptoms and characteristics
Diagnosis involves comparing patient symptoms against the listed symptoms within each category
All or nothing approach; uses a yes/no approach; have a diagnosable disorder or do not
Must be valid (diagnosis of disorder actually matches the symptoms)
Must be reliable (consistency; diagnosis will be the same each time for the set of symptoms)
Must be inter-rater reliability (consistency of diagnosis from a variety of mental health professionals)
a. DSM-V: Diagnostic & Statistical Manual of Mental Disorders
- System most widely used method to identify, classify and diagnose
- Key principle: Diagnosis is made from specific symptoms
- Important feature of the DSM-IV-TR = does not suggest causes rather it names
the disorders and describes the specific symptoms
- 365 disorders comprehensively described and grouped into 17 categories
- Symptoms:
 Inclusion criteria: symptoms that must be present for diagnosis;
 Exclusion criteria: symptoms that must not be present;
 Polythetic criteria: only some symptoms need to be present for
diagnosis – e.g. “3 of the following 8.”
- Provides additional information (e.g. prevalence, age that is most likely will
occur, genetic predisposition etc.)
- MULTI-AXIAL
Axis
Name
Explanation
Example
Number
1
Clinical disorders
Current mental condition
Depression
Anxiety
2
Personality &
Personality: involves
Borderline
Mental Retardation socially unacceptable
Personality
behaviour
Intellectual: below
Autism (Savant)
average level of
intelligence
3
General Medical
Medical conditions that
Alzheimer’s as a
Conditions
may have caused
result of brain
disorders from Axis 1 & 2
injury to the
hippocampus
4
Psychosocial &
Potential stressors
Social isolation
Environmental
relevant to disorders but
Job loss
Problems
considered before
Legal problems
treatment
5
Global Assessment Scale (1 – 100) rating of
1 - 1 0: danger of
of Functioning
social, occupational and
self-harm
(GAF)
psychological functioning
91 – 100: superior
functioning
b. ICD-10: International Classification of Disease and Related Health Problems
-
A coding of diseases, symptoms and causes (published by WHO)
Distinguishes between mental and behavioural disorders (cf. DSM = only mental)
Identifies the disorder that best matches the reported symptoms
Less detailed than the DSM
Doesn’t provide information about the typical course, prevalence and prognosis
STRENGTHS:
- Very comprehensive list of disorders, symptoms and additional information i.e. High degree of detail
- User-friendly system:
 This fits with the ‘yes/no’ approach used by most healthcare professionals
- Allows clear-cut diagnosis of mental disorders (this is the main purpose of the categorical approach)
- Enhances communication between professionals by providing a common language:
 Diagnostic labels can convey a large amount of information quickly and conveniently
LIMITATIONS:
- Historically low inter-rater reliability (different conclusions reached by different professionals):
 Much better now with DSM-IV-TR and ICD-10: up to 70% agreement between mental health
professionals
 BUT still as much as 30% disagreement in classification of people with mental disorders and much lower
inter-rater reliability for personality disorders
- Lots of overlap between symptoms can make diagnosis difficult
- Substantial loss of valuable clinical information: individuality of the patient becomes overlooked when they are
simply categorised
- Categorisation and ‘labels’ can result in stigma
 Complete Activity 11.12 and 11.14
PAST EXAM QUESTIONS
1) The ICD and DSM systems are widely used to
a) Classify mental disorders
b) Diagnose and treat mental and physical illness
c) Establish precisely the mental state of a person so that a specific treatment can be applied
d) Are well developed and highly reliable classification systems that require no further clinical judgment
2) Although the ICS and DSM systems have much in common, they differ in one major way. In contrast to the ICD
the DSM has
a) A multi-axial approach that provides a more comprehensive assessment than does the ICD
b) A uniaxial system that is simpler to interpret than the multi-axial ICD system
c) A graded or dimensional scale to assess strength of the presented symptoms of sign
d) A categorical measure to decide whether the person is classified as either well or unwell
3)
4)
5)
6)
What is meant by the categorical approach to the classification of mental illness? (1 mark)
List one advantage of the categorical approach of classification. (1 mark)
What is meant by a multi-axial system of classification as used by the DSM? (2 marks)
In addition to the main mental illness diagnosis, describe two other types of information the DSM assesses. (2
marks)
UNIT 4
AREA OF STUDY 2
MENTAL HEALTH
Key Knowledge 2:
Systems of classification of mental conditions and disorders: underlying principles of classification;
strengths and limitations of discrete categorical (DSM-IV and ICD-10) and dimensional (graded and
transitional) approaches to classification of mental disorders
SYSTEMS OF CLASSIFICATION OF MENTAL CONDITIONS & DISORDERS
Two main classifications: categorical and dimensional which are often used together
2)
-
DIMENSIONAL
Also called spectrum or continuum system
Dimension = cluster of related psychological/behavioural characteristics that occur together
Quantifies symptoms and other characteristics with numerical values
 These values are compared with the statistically ‘normal’ expected values for each characteristic
- E.g. Eysenck Personality Questionnaire: does not aim to decide if a person ‘has’ or ‘doesn’t have’ a personality
disorder but instead measure three dimensions (extraversion, neuroticism, psychoticism)
- Alternatively, a grade (score) of a disorder could be used to determine overall functioning or impairment
-
Key feature: a mental disorder isn’t considered in terms of whether it is present or absent, rather it focuses on
the severity of dysfunction on a particular dimension. No labelling
-
Key feature: Questionnaires/Inventories can produce a profile (graphical representation) which reflects the
uniqueness of each individual’s thoughts, feelings and behaviours associated with their mental disorder
E.g. MMPI
-
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Hs Hypochondriasis Concern with bodily symptoms
D Depression Depressive Symptoms
Hy Hysteria Awareness of problems and vulnerabilities
Pd Psychopathic Deviate Conflict, struggle, anger, respect for society's rules
MF Masculinity/Femininity Stereotypical masculine or feminine interests/behaviours
Pa Paranoia Level of trust, suspiciousness, sensitivity
Pt Psychasthenia Worry, Anxiety, tension, doubts, obsessiveness
Sc Schizophrenia Odd thinking and social alienation
Ma Hypomania Level of excitability
Si Social Introversion People orientation
STRENGTHS:
- By quantifying information, a richer more detailed description of an individual’s disorder can be found (rather
than yes/no approach in categorical)
- Reduced stigma as labelling isn’t used:
 Instead a profile is created
 Patients are viewed as having extreme variants of common traits, rather than being labelled as
completely ‘different’.
LIMITATIONS:
- There is no standardised inventory to compare individual scores to, thus diagnosis is difficult :
 Mental health professionals need to create the questions and scales themselves (may have to rate a
client on up to different 40 dimensions) = Time consuming and difficult process
- Disagreement among professions and researchers on the number of dimensions that suitably represent the wide
range of mental disorder symptoms people can experience:
 If there are too many dimensions, assessment could become overcomplicated
 Complete the strengths/limitations table
 Complete Chapter 11 True/False questions pg. 578
 Complete Chapter 11 Review questions pg. 579-581
4.2 MENTAL HEALTH: STRENGTHS AND LIMITATIONS OF THE TWO CLASSIFCATION SYSTEMS
APPROACH
CATEGORICAL
1) _________________
2) _________________
KEY FEATURE:
DIMENSIONAL
KEY FEATURE 1:
KEY FEATURE 2:
STRENGTH
LIMITATION
4.2 MENTAL HEALTH
CHAPTER 12: STRESS AND HEALTH
PHYSIOLOGICAL RESPONSES TO STRESS

Fight/Flight Response
What is it?
Why does it exist?

Draw a flow chart of the HPA axis to demonstrate what happens in the brain and body during the fight/flight
response

Discuss what happens to the following bodily systems/structures involved in the stress response

NERVOUS
SYSTEM
MUSCULOSKELETAL
SYSTEM
RESPIRATORY
SYSTEM
ENDOCRINE
SYSTEM
GASTROINTESTINAL
SYSTEM
REPRODUCTIVE
SYSTEM
CARDIOVASULAR
SYSTEM
CASE STUDY: One week before Alison’s exam, she was staying up late every night studying. She was tired
although seemed to be managing her workload. Two nights before her first exam Alison witnessed her dog being
hit by a car which distressed her. On the morning of her first exam she woke up with a headache, a sore throat
and aches and pains in her joints.
1) Name the main stages of Selye’s General Adaptation Syndrome (GAS)
2) Name and explain the stage of GAS that Alison is most likely to be in.
3) Explain, in terms of prolonged physiological arousal why Alison was susceptible to illness.
4) What role does the immune system and white blood cells play in protecting the body from disease.
ROSENHAN’S STUDY OF SANITY AND LABELLING
Rosenhan and colleagues had eight ‘sane’ people gain entrance to 12 different hospitals for mentally ill people.
None of the eight individuals (pseudo-patients) had ever experienced any serious symptoms of mental illness. Of
the eight pseudo-patients, three were women and five were male. The youngest was a psychology graduate in his
20’s and the others were older. Among the pseudo-patients were three psychologists, a psychiatrist, a painter
and a housewife.
The pseudo-patients each gained entry to a hospital stating that they were hearing voices. They told
admissions staff at the hospital that they heard voices of the same gender as themselves and that the voices
were often unclear but at times could be heard saying words such as ‘empty’, ‘hollow’ and ‘thud’. All eight
pseudo-patients were admitted to the various hospitals when they were presented with this one symptom. All but
one was diagnosed as suffering from schizophrenia.
However, beyond their initial declaration that they were hearing voices, they behaved as they would
normally, and continued to do so when they were admitted. They used fake names and some of them used fake
employment details (the psychiatrists and psychologists did not give these as their professions); however, all
other details about personal history and traits were presented as they actually were. None of the histories were
seriously pathological in any way.
While in the hospitals, the pseudo-patients followed instructions from attendants, were administered
medications (but did not swallow them) and spent some time writing down their observations. They initially
wrote secretly, but after some time it became apparent that nobody cared whether they were constantly writing,
so they started to do it in public. Presumably their writing behaviour was considered part of their mental
disorder.
The length of stay in the hospitals varied from seven days to 52 days, with the average being 19 days. The
pseudo-patients entering the hospitals were not told when they would be released – each was told that they
would be released when they were well. In other words, they had to convince staff members that they were
‘sane’.
Ironically, many of the true patients in the hospitals did not believe the pseudo-patients had any kind of
mental disorder – 35 out of 118 true patients voiced their suspicions, stating things such as, ‘You are not crazy’,
‘You’re a journalist’ .
Each of the pseudo-patients managed to gain release. They were all released on the basis that they were ‘in
remission’ from their mental disorders.
Rosenhan and colleagues concluded that staff that were trained to detect mental illness and abnormal
behaviour could not recognise normal behaviour once a label had been assigned to an individual stating that they
suffered from a mental disorder. It appeared that once the initial impression has been formed, the psychiatrists
label has a life and influence of its own, so that once labelled as schizophrenic, there is an expectation that
individual will continue to be schizophrenic even if they do not show any symptoms.
When Rosenhan published the results, staff at a research and teaching hospital doubted that such errors
could happen in a hospital. Rosenhan consequently conducted a follow-up study at the hospital where the
doubting staff worked. Rosenhan informed the hospital that a number of pseudo-patients would attempt to
admit themselves to the hospital over a three-month period. Each staff member was asked to rate all patients
being admitted to the hospital on a 10-point scale, showing whether they thought the patient was legitimate, or
a pseudo-patient faking their symptoms.
Of the 193 patients who were admitted for treatment during that time, 41 of them were considered to be
suspected pseudo-patients by at least one member of staff, while 19 patients were suspected of being ‘sane’ by
at least one psychiatrist and one other staff member. However, unbeknownst to the hospital staff, no pseudopatients were actually sent to the hospital by Rosenhan and colleagues during this time !
These findings have been criticised by others, but the study does raise some important questions regarding
the treatment of individuals suffering from mental disorders. A person cannot be a disorder; they can only suffer
from one. Labelling can be detrimental to those unfortunate enough to suffer from a mental disorder, though
with improved education, the effects of labelling and the stigma attached to mental disorders may be reduced in
the future.
1.
2.
3.
4.
5.
6.
7.
8.
Identify the aim of the initial study
Identify the participants in the initial study
Name the experimental procedure used in this study
What were the results of the initial study
Rosenhan and colleagues used some deception in these studies. Why was this ethical?
What was the Rosenhan and colleagues conducting a follow up experiment?
How do these studies suggest that stigma can be reduced in the future
How could the dimensional approach to diagnosis have been more advantageous to the DSM-IV or ICD-10 in
these cases?