PSYA02H3 Chapter Notes - Chapter 16: Bibliotherapy, Disulfiram, Deinstitutionalisation

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21 Mar 2015

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PSYA02 Chapter 16 Notes
16.1 – Treating Psychological Disorders
- Things that reflect a general normalization of the whole idea of psychological disorders and lessening of
the stigma toward mental illness include TED Talks and celebrities revealing their own traumas
- Women participate in therapy more often than men, and people aged 35 through 55 seek treatment more
often than younger adults and the elderly
- In Canada, Asian and Natives are both less likely to seek mental health treatment than Caucasians
oNorth Americans in general seek it more than Israel, Hungary, Japan, and Korea
- Of 1600 adults who had been diagnosed with depression or an anxiety disorder, only 30% were
receiving some form of therapy
oSome even significantly delay doing it after becoming aware of their mental health status
- There is no objectivity in mental illnesses, and no litmus test that can tell a person with a high degree of
certainty that they need to seek help
oPeople end up believing that their sadness/depression is a part of their daily life
- People don’t want to admit that they’re mentally ill, and so they try to minimalize their symptoms,
basically tricking themselves into believing they’re healthier than they really are
oDoing it possibly out of fear of being seen as weak or personal failure, or unwilling to risk the
social stigma that they fear might embarrass either themselves or their families
- Some people can be skeptical of their physicians and their efficiency of different treatments
- In one study, 99% of respondents said they would seek mental health treatment if they believed it would
be helpful
- In many professions, mental illness carries a strong stigma, resulting in people with psychological
disorders experiencing discrimination at the workplace
oSocial costs when it comes to family, friends, and personal relationships
o1 out of every two Canadians admits they probably wouldn’t socialize with a person who has
mental illness, and 1 out of every four admits they’re afraid of being around people who have a
mental illness
- In North America, theres extra pressure on men to avoid treatment, because “needing help” and going to
therapy seem incompatible with the idea of being “strong” and independent, key aspects of the male
gender role
oMales won’t talk about their emotions or vulnerabilities
o“Real Men, Real Depression” campaign, social marketing messages succeed in increasing the
likelihood people will seek help
- Money has a particularly profound influence on the way that the mental health system functions, and the
kinds of treatments that are available for many people
oPsychotherapy can be very expensive, generally costing more than $100/hr or more, not
including transportation, possibly child care
oGovernment health-care coverage in Canada only includes treatment by psychiatrists, leaving
counselors, psychologists, and others less likely to help people who can’t afford it
oIndividuals from lower-class families decide to just try and get over it, but can increase their
dysfunctional lives and eventually be unable to function properly
oPrivate psychotherapists are scare and needed; sometimes community mental health centers offer
it depending on the patient’s income and insurance status
- In North America, people can be compelled through the courts or on the advice of social service
agencies or doctors to be treated for mental illness
oDue to the engagement of highly erratic/disturbing behaviour, resulting in legal trouble
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oOutpatient commitment is a highly contentious issue because it effectively strips people of some
of their basic rights (although it could result in opinions of it being unethical)
oIf a person who was misjudged receives unnecessary drugs, it can alter their brain functions
and/or other dangerous side effects
oMany people placed in involuntary treatment programs feel coerced and resentful, and not
everyone benefits
oU.S.:Individuals who are lower in socioeconomic status and from African-American or Latino
backgrounds are significantly more likely to receive court-ordered treatment
Quick Quiz 16.1a
1. People who would argue against the practice of involuntary commitment tend to believe that
a. Committing people against their will is wrong because it removes peoples basic human rights
and freedoms
b. Imposing treatments, such as drug treatments, onto people is unethical because the side effects
and unintended consequences of the treatment itself may further harm the person
c. The decision to commit people to treatment can be based due to prejudice and stereotypes that
exist in society
2. Which type of barrier is in evidence when people believe their problems are not important enough for a
therapist? Minimalizing
3. People’s fears that they may be stigmatized for having a mental illness are understandable;
unfortunately, there may often be professional or social costs when others know someone has had a
psychological disorder
- Mental health services include inpatient care, outpatient office visits, use of prescription drugs, attending
therapy sessions, and taking part in support groups
-Clinical psychologists: Have received Ph.D. level of training, and are able to formally diagnose and
treat mental health issues ranging from the everyday and mild to the chronic and severe
-Counselling psychologists: Mental health professionals who typically work with people needing help
with more common problems such as stress, coping, and mild forms of anxiety and depression, rather
than severe mental disorders; can have either Masters or Ph.D.
oCan work in an office, institution, hospital, or conduct testing and research
-Psychiatrists: Medical doctors who specialize in mental health and who are allowed to diagnose and
treat mental disorders through prescribing medications
oWork within biopsychosocial perspective, perform psychological counselling and therapy, or
work closely with other professionals who provide such services
oFound in a variety of settings, but mainly hospitals treating people
- Asylum treatments hardly qualify as treatments because there was no hope that the individual would get
better; goal was to protect the public and provide basic care to the mentally ill
- Inmates of institutions were subjected to brutal confinement, torture, and an almost complete lack of
humane conditions
oBedlam = referring to the horrific operations of the St. Mary of Bethlehem hospital; since it
wasn’t easy to remember the name, the name “bedlum” stuck instead to define chaos
- Philippe Pinel: First to be granted permission to remove the chains from the inmates of French hospitals,
resulting in ideas of more humane treatments
- Dorothea Dix: Campaigned heroically to improve the conditions of institutionalized patients and was
highly instrumental in shifting society’s attitudes
- Asylums continued to be in use until around 1960s
-Deinstitutionalization: Mental health patients were released back into their communities, generally
after having their symptoms alleviated through medication
- Mental health care providers have gathered together many resources and strategies to help people in
some form of distress
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- Instead of removing the ill from the society, the idea became to treat the ill from harm so they can return
to society quickly
-Residential treatment centers: Housing facilities in which residents receive psychological therapy and
life skills training, with the explicit goal of helping residents become re-integrated into society as well as
they can
oFunction like hospitals inside medium-security prisons, with a high staff-to-resident ratio
ensuring that resident remain under control
oIntended for individuals with more dangerous histories of their mental illness
- After deinstitutionalization began, homelessness and substance abuse became a major problem for the
severely mentally ill, who were not always able to reintegrate into society or were not cared for by their
-Community psychology: An area of psychology that focuses on identifying how individual’s mental
health is influenced by the neighbourhood, economics and community resources, social groups, and
other community-based variables
oPreventing disorders by seeking to enhance healthy family relationships to strengthen people and
make them more resilient to the kinds of stresses that can otherwise undermine mental health
- Invovled with issues other than mental health as well, such as environmental sustainability and social
Quick Quiz 16.1b
1. Which type of provider is generally permitted to prescribe medications? Psychiatrist
2. Community psychologists study how individuals’ mental health is influenced by the neighbourhood,
economics, social groups, and other community-based variables
3. The social movement against keeping the mentally ill in asylums is known as deinstitutionalization
- In the 1990s, the American Psychological Association set up tasks forces to evaluate different therapy
practices, making their findings and recommendations available online
oProperly designed studies are needed to examine the effectiveness of different therapeutic
approaches, and these approaches should evolve depending on what research suggests works
-Empirically supported treatments: (Evidence-based therapies) Treatments that have been tested and
oIt is ethically problematic to place people into a control group, because it effectively denies them
treatment that they need
- Testing the effectiveness of therapy using some therapists may not generalize to others, because some
therapists will be much more skilled than others
- Therapists who are more socially skilled, who show warmth, concern, and empathy, tend to be more
effective; clients who are more open minded are more willing to trust
- Each therapy session is unique; very difficult to adequately test the effectiveness of many therapeutic
approaches to the rigorous extent required for empirical support
-Bibliotherapy: The use of self-help books and other reading materials as a form of therapy\
Quick Quiz 16.1c
1. Therapeutic alliance is the relationship that emerges in therapy between the therapist and client, and is
an important determinant of the therapys effectiveness
2. What does it mean to say that a therapy has “empirical support”? Research studies confirm that its
effective compared to no treatment and possible compared to other alternatives
3. Which of the following conclusions best summarizes the effectiveness of bibliotherapy? It may be
helpful to many people, but it its results are not consistent
16.2 – Psychological Therapies
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