Normality, Mental Health and Mental Illness

Normality, Mental Health and Mental Illness Its all in your head - literally

Something to be aware of first!! • Studying mental health does not in any way qualify you (or me for that matter!) to diagnose mental disorder!!! • Only licensed mental health professionals are able to make a diagnosis. • When dealing with sensitive mental health matters, students: • should not necessarily interpret their own experiences as signs of pathology • are not in a position to diagnose problems or offer any counselling or therapy. • In addition, students should be given information about sourcing available treatment services within and outside school. • School counsellors • Headspace.org.au – Australia’s National Youth Mental Health Foundation, Beyond Blue

SOME STATISTICS • 20% of the worlds population has a mental disorder at any given time • 30% of all people will experience a diagnosed mental disorder at some stage in their life • So chances are you either know someone now, or will in the future, who is coping with a mental disorder.

More Detailed Statistics • One out of every five Australians [about 20%] will experience some form of mental illness each year. Three out of every ten [about 3 %] will be seriously affected. • Depression and anxiety are the most prevalent mental disorders experienced by Australians. Depression alone is predicted to be one of the world’s largest health problems by 2020. • Nearly one in 10 Australians will experience some type of anxiety disorder each year – around one in 12 women and one in eight men. • One in four people will experience an anxiety disorder at some stage of their lives. • Around one million Australian adults and 100,000 young people live with depression each year. • On average, one in five people will experience depression in their lives; one in four females and one in six males.

MORE STATISTICS • Around 14% of 12-17 year olds and 27% of 18-25 year olds experience a mental illness in any given year. • At least one third of young people have had an episode of mental illness by the age of 25 years. • The majority of mental illnesses begin between the ages of 15-25 years. • The 2001 National Health Survey estimated that 1.8 million Australians (9.6% of the population) had a longterm mental or behavioural problem of more than 6 months duration. • Approximately twot hirds of people with a mental illness do not receive any treatment in any 12 month period. • Mental disorders and suicide account for 14.2 % of Australia’s total health burden • Estimates suggest that up to 75 % of people presenting with alcohol and drug problems also have additional mental health problems. • Reports indicate that up to 85% of homeless people have a mental illness.

Study Design Dot Points • concepts of normality and differentiation of mental health from mental illness • 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 • use of a biopsychosocial framework (the interaction and integration of biological, psychological and social factors) as an approach to considering physical and mental health

Normality and Abnormality Approaches to defining ‘Normal’ and ‘Abnormal’

The Big Bang TheorySeries 1, Episode 10 – The Loobenfield Decay • First Scene • http://www.cucirca.com/2009/01/25/the-big-bang-theory-season-1-episode-10-the-loobenfeld-decay/ • http://www.5min.com/Video/Dr-Phils-Explains--the-Mind-Body-Connection-114222921

Normality and Abnormality • Normality is often defined as a pattern of thoughts, feelings or behaviours that conforms to a usual, typical or expected standard. • However it is recognised that what is a ‘usual, typical or expected standard’ depends upon many different factors. • The meanings of normality and abnormality in relation to thoughts, feelings and behaviours can vary. • Through the history of psychology there have been many proposals for how to describe normality and abnormality. • Six main influential approaches • Each views normality and abnormality from a different perspective • Each has a different emphasis on how normality and abnormaiity are best considered.

Approaches to Defining Normality and abnormality FUNCTIONAL • Thoughts, feelings and behaviours are viewed as normal if the individual is able to cope with living independently in society. • It is normal to be able to feed and dress yourself and come to school each day. • It is abnormal to be so lethargic that you cannot get out of bed all day. HISTORICAL • What is considered normal and abnormal in a particular society or culture depends on the era (period of time) when the judgement is made. • Giving a student the strap for bad behaviour was normal in the past but is abnormal now. • A married female working used to be considered abnormal but is now normal MEDICAL • Abnormal thoughts, feelings or behaviour s have an underlying biological cause and can be diagnosed and treated. • If someone sees or hears things that aren’t there, this may be diagnosed as schizophrenia and treated with medication SITUATIONAL • Within a society or culture, thoughts, feelings and behaviours that may be considered normal in one situation may be considered abnormal in another situation. • Wear PJ’s to bed but not to school • Laugh at a party but not at a funeral SOCIO-CULTURAL • Thoughts, feelings and behaviour that are appropriate or acceptable in a particular society or culture are viewed as normal and those that are inappropriate or unacceptable are considered abnormal. • Loud wailing at a funeral • Females having to line up separately and wait longer than males STATISTICAL • Any behaviour or characteristic in a large group of individuals is distributed in a normal distribution so if a large majority (the statistical average) of people behave in a certain way, that is considered normal whilst behaviours that are shared by only a small minority are considered abnormal. • Laughing when tickling is normal as most people do it • Being home schooled is abnormal as not many people do it

Normality and abnormality - statistical • Normal Distribution = behaviour in a large group of individuals that is distributed in a particular way • Statistical Average = the majority that demonstrate this behaviour = normal • Statistical Extremity = the minority that demonstrate this behaviour = abnormal

Normality and abnormality - statistical • Normal behaviour = a characteristic that is common in a large group • Disadvantage: Not everyone is normal or average in all ways. It suggests there are distinct dividing lines between normal and abnormal behaviour. • Central Tendency (average) = most results being in the middle • Mean= average of all the individual scores • Average = add up all the scores / how many scores there are • Median = the middle score of the group • Mode= the most common score • Range = spread of scores between the highest and lowest. • Highest number-lowest number • Standard deviation = the average distance each score falls from the mean

The bell or ‘normal’ curve

Abnormal? By which measure?

Abnormal? By Which measure?

Abnormal? By which Measure?

NORMALITY AND ABNORMALITY • Psychologists recognise that none of these approaches to describing normality or abnormality is entirely satisfactory on its own • Each approach has contributed to the understanding of normality and abnormality. • The various factors all need to be considered when using the terms normal and abnormal in relation to someone’s thoughts, feelings or behaviours • The way normality and abnormality is viewed and describes provides the basis of diagnosing and treating mental disorders.

Abnormality • Pinpointing the meaning of abnormality in relation to mental processes and behaviours has implications for the diagnosis and treatment of mental health problems. • Some definitions focus on the concept of abnormality as being ‘away from’ what is considered normal. • These are useful for providing a basis from which theoretical models and principles can be developed or applied in describing and explaining abnormality. • Some definitions have a practical emphasis that takes account of the effects of the thoughts, feelings and behaviours on the individual and others around them. • These are useful for diagnosing and treating mental health problems.

Abnormality – a working definition • Abnormality – pattern of thoughts feelings and behaviours that are deviant, distressing and dysfunctional. • Deviant = inappropriate or unacceptable • Distressing = unpleasant or upsetting • Dysfunctional = interfere with ability to carry our daily activities in a normal way Serial killer Ted Bundy fits our definition of abnormality

Activities to Consolidate your Understanding • Learning Activity 11.2, page 545 – Review Questions.

Health Versus Illness

health vs illness • (WHO definition) Health = a state of complete physical, mental and social wellbeing and not merely the absence of illness or disease • Physical, Mental and Social Wellbeing are equally important • Physical Wellbeing involves the body: eating a well-balanced diet, exercising regularly, resting when required, maintaining appropriate body weight etc. • Mental Wellbeing involves the mind: expressing feeling calmly, rational thinking, approaching life with view to learning through experience and learning continues through the lifespan etc. • Social Wellbeing involves personal relationships and interactions with others: getting along with others, giving and receiving social support when needed, making and keeping friends. Devoting more attention to one aspect of health and neglecting others can lead to “illness” or “disease”. • Illness = a person’s subjective experience of feeling unwell in relation to one or more aspects of their health. • Involves how an individual thinks and feels about their physical, mental and/or social wellbeing. • Personal interpretation • Disease = identifiable physiological changes associated with an abnormal bodily condition. • A medical doctors objective findings

ILLNESS • Symptoms associated with illness and their onset may be: • acute (sudden onset and lasting for a short duration) or • chronic (gradual onset and be frequently occurring or longlasting) • Vary in intensity (effects may be more or less serious in terms of their consequences for the individual). Often when a person reports illness, there is evidence of “disease”.

DISEASE • Disease often accompanies illness but this is not always the case. • It is possible to have a disease (e.g. brain tumour) without feeling ill. • People with the same disease may experience illness associated with the disease in different ways. • LEARNING ACTIVITY 11.4 Q. 1, 2 and 3

Physical health vs Physical illness • For most people this distinction is quite clear • Physical health = the body’s ability to function efficiently and effectively in work and leisure, to be in good condition, to resist disease and to cope in threatening and emergency situations • The signs of good physical health can be objectively assessed by a medical doctor. Eg Heart rate, BP, normal body temperature, cholesterol level, breathing rate, eyesight, hearing, feeling bright and alert (no fatigue), regular stools, normal urine, healthy gums • Physical Illness = our subjective experience of a disease or physical health problem that interferes with the normal functioning or our body and impacts on our everyday life

Physical Illness • Use the term when physical problems experienced by a person are: • more serious than a temporary ache or pain • likely to persist for a relatively long time • likely to require a longer term treatment plan • E.g. Diseases underlying physical illness could include diabetes, kidney or heart disorder, multiple sclerosis, HIV, cancer and other serious tumours. • Diseases are distinguished from physical health problems which occurs when our body doesn’t function as well as it could and therefore often also underlie physical illness. • These problems though, are generally less serious in nature than a disease and are likely to pass, often without medical intervention.

Mental health Vs mental illness • Mental health = capacity of an individual to interact with others, cope effectively with problems and stress • Mental health problem= when the difficulties experienced by a person are mild, temporary and able to be treated within a relatively short period of time • Mental illness = psychological dysfunction that usually involves impairment in coping ability with feeling and behaviours that are atypical and inappropriate within their culture • Mental illnesscan sometimes be referred to as a psychological dysfunction experienced by an individual and usually involving • Emotional distress • Impairment in the ability to cope with everyday life • Thoughts, feelings and/or behaviour that are not typical of the person or notappropriate within their society and/or culture • See Table 11.1, page 548 – Characteristics of Mental Health, Mental Health Problems and Mental illness.

What differentiates Mental Health from Mental Illness? • When does a person become mentally ill, rather than just having poor mental health? • When the pattern of cognitions/ mood/ behaviour present as dysfunctional (i.e.: they interfere with the general well-being and functioning of a person in their life) then a person is said to not simply have poor mental health, but rather and more specifically, be characterised as having a mental illness.

Activities to Consolidate your Understanding • Learning Activity 11.4, page 547 – Review Questions. • Learning Activity 11.6, page 553 – Review Questions. • Learning Activity 11.7, page 554 – Visual Presentation of Normality, Mental Health and Mental Illness. Good revision!

MAINTAINING GOOD MENTAL HEALTH – IT’S YOUR ABC! • Easier to describe how to look after physical health than mental health • Good mental health helps us to more fully enjoy life and appreciate the people and environment around us! • We respond better to the stressors and challenges of daily life • We use our abilities to the fullest • We make the most of opportunities when our mental health is strong.

ABC! • The Mental Health Council of Australia identifies 3 main categories of activities we can do to build and maintain good mental health. A – Actby keeping yourself as active as possible, physically, socially and mentally. e.g. Exercise, enjoy hobbies, treat yourself well to activities you enjoy (bubble bath, movies) B – Belongby connecting to your community. e.g. Join groups, meet neighbours, friends, share a laugh, do one thing at a time and enjoy it C – Committo looking for challenges, having a go and getting involved. e.g. “collect” positive emotional moments, learn ways to cope with negative thoughts, set personal goals, keep a journal, express yourself, volunteer to help others.

The Biopsychosocial Framework

The Biopsychosocial Framework • An approach to describing and explaining how biological, psychological and social factors combine and interact to influence a person’s physical and mental health. • Considers the biological, social and psychological influences in the assessment and treatment of mental health and illness. • Biological factors = physiologically based or determined influences, often not under our control, such as the genes we inherit and our neurochemistry. • Psychological factors = influences associated with mental processes such as how we think, learn, make decisions, solve problems, perceive our environments, manage stress, reconstruct memories etc • Social factors = interacting with others, interpersonal relations, support available from others, socio-cultural factors such as values and traditions, family upbringing, education, income, access to medical care etc

The biopsychosocial framework Mental health and wellbeing depends on a combination of biological, social and psychological factors

The Biopsychosocial Framework • Reflects a holistic view of health – whole person must be considered within their unique environment • Only focusing on one or two domains, rather than three, is likely to give an incomplete picture • Each of the three domains is equally important for physical and mental health • Specific factors may have more or less of an influence on an individual’s health than others • Factors may combine and interact in complex ways • This complexity explains individual differences in the experience of illness or disease and informs the treatment and management plan of the illness or disease.

The Biopsychosocial Framework • E.g. A personality disorder could be explained by the combined influence of: • Individual’s inheritance of certain genes and impaired brain functioning in the part that controls impulsive behaviour (biological factors) • Poor self image and an intense fear of abandonment • (psychological factors) • Strict upbringing and lack of skills required to develop and maintain social relationships (social factors) The biopsychosocial framework views all three domains equally important.

Factors within each domain may combines with other factors in the same domain as well as with other factors in the other two domains. • It’s a complex interaction of multiple factors! • This helps us to understand the individual differences in health and the experience of illness and disease.

Quick Activity • Draw up a table with three columns headed: • Biological • Psychological • Social • Classify each of the following into one of the columns: • Children leaving home, abuse, heritability of alcoholism, loss of partner or child, chemical make-up, financial problems, metabolic rate, feeling happy, workplace discrimination, relationships, chicken pox, constant negative thoughts, separation or divorce, brain damage, friends

CASE STUDY – Application of the Biopsychosocial Model to a real life situation. • “Con is an Australian-born Greek. He is a Year 12 student who is under intense pressure from his parents to maintain an A average and he is constantly fighting with his parents. In addition, he has just broken up with his Japanese girlfriend primarily because of parental interference and cultural expectations from both sides. Even though Con is upset and depressed about everything going on in his life, he agrees to go to a party with a mate. While there, he is offered a ‘joint’. Contrary to his values and beliefs and due to peer pressure, Con smokes the entire thing. However, he is unaware that he has a strong family history of schizophrenia. Unfortunately for Con, this single exposure to the drug results in him hearing voices (auditory hallucinations) and feeling like someone is watching him. As Con’s behaviour becomes increasingly bizarre, his friends call for an ambulance. Con is one of the unlucky ones as now, not only was he feeling sad, anxious and stressed form a range of personal issues, he has now experiences the first of many psychotic episodes characteristic of schizophrenia.”

Application of the BioPsychoSocial Model to the Treatment of Schizophrenia

Activities to Consolidate your Understanding • Learning Activity 11.8, page 557 – Review Questions 1 to 6.

Classification of Mental disorders

classification of mental disorders • All sciences classify! • Classification = organising items into groups based on their shared characteristics, common properties or distinguishable features that are alike or related in one or more ways. • Enables easy organisation: • Groups of items that share a particular set of properties belong in the same class or category • Classes may be further divided into subclasses. • Makes it easier to identify and understand relationships between different groups • Assists communication between people as everyone uses the same terms as labels for the categories.

CATEGORIES AND SUBCATEGORIES • A category or class is a group of items that shares a particular set of properties. • A class may be further divided into a number of subcategories or subclasses. • Generally the more subcategories that are used in a classification system, the more the items in subcategories share one or more properties that are a specialised version of the set of properties shared by the original category. • Whatever the number of categories or subcategories in a given classification system, they are given labels, or “named” for identification purposes.

Systems of classification of mental disorders • Currently two main approaches to classifying mental disorders or illness • Categorical approaches (‘yes’/’no’) • Classify a person’s symptoms in terms of which specific category of mental disorder they best fit, or belong to. • Organises mental disorders into categories, each with specific symptoms and characteristics. • Yes/No approach – focuses on diagnosing whether a patient does or does not have a disorder • Diagnosis involves a comparison of patients symptoms to the listed symptoms within each category • Check your patients list against the lists in the DSM-IV to find a fit – then make diagnosis

Systems of classification of mental disorders • Currently two main approaches to classifying mental disorders or illness: • Dimensional approaches • Classify a person’s symptoms in terms of how muchthey demonstrate certain characteristics • How Much approach – Clients are assessed on the relevant dimensions and then assigned numerical values in each dimension (e.g. 1-10 scale of anxiety – where 1 is minimal and 10 is extreme) • Diagnosis involves asking how much of that characteristic is normal and if the numerical value assigned to the patient is outside normal, they have that particular characteristic • Measure all characteristics and the combination of scales that are statistically extreme might point to the type of illness being suffered

Normality, Mental Health and Mental Illness