Lesson 2: Fundamentals of Mental Health


Attention

 

Click HERE to view this video directly on YouTube

While this may seem crude and politically incorrect, a landmark study was published in l973 by David L. Rosenhan. It appeared in the Journal Science, 179, 250-258, and was entitled "On being sane in insane places." If the date seems ancient, it could not be MORE relevant today. With the publication of the latest Diagnostic and Statistical Manual- Five, from the American Psychiatric Association, 2013, understanding and diagnosing mental illness is center stage again.


Learning Outcomes

Upon completion of this lesson's material, students will be able to:

  • Understand relevance of defining normalcy.
  • Understand danger of underinclusion.
  • Understand danger of overinclusion.
  • Understand potential for doing more harm than good in treatment.

Teaching

Reading

Lecture

Click HERE to visit the PBS website on "The Lobotomist"

The documentary is about Walter Freeman's career. It is very "gritty" material. Horrific in what it depicts, and worse for the clinical outcomes of procedure(s). It is crucial for students to understand how far psychiatry has come. From what was once intended to be prudent medical management of disordered behavior, to an interval of custodianship, when nothing other than hospitalization seemed to be an option, to what many hope will become the re-medicalization of the field by way of advances in neurosciece through imaging technologies, and of course, a better understanding of the role of heredity here.

President Obama's initiative, announced April 2. 2013, was Brain Research through Advancing Innovative Neurotechnologies: B.R.A.I.N. While seeming new, what the central issue here is to understand on the cellular and molecular levels, the structure and function of the brain and nervous system.

I know you hear this all the time about how "lucky" you are to be taking a course in a field new to you, because it is changing as course unfolds. But, really (REALLY!), this is true for community mental health in ways that were never so before.

The World Health Organization has predicted that by the year 2020, the most common medical/psychiatric complaint will be major depression. The history for treating depression has been very complex. Currently, when medication, psychotherapy, and family treatment fail, an option may be electro-convulsive therapy. While this too has a nightmare history not unlike lobotomies. it is practiced today nonetheelss. With meticulous preparation, including hospitaliztion, sedation, muscle relaxation, and pain management, the procedure has proven of value for some. Students may recall a movie, "One Flew Over the Cuckoo's Nest." The character named Murphy was NOT lobotomized. He was punished with excessive electro-convulsive shock. It destroyed his mind. Today, this therapy is a court of last resort. Strange as it may seem, it is difficult to explain how and why it produces relief when it does.

So, here is a strategy from the history of the mental health field, still in play.


Assessment

Lesson 2 Quiz

  1. Consider the model upon which psychiatric diagnosis rests. It is a disease model, but, frequently identifies troubled behavior, without really addressing the cause. Can you begin to see the problems for prevention, treatment, and maintenance of therapeutic gain? I would venture to guess there is no one taking this course who has not seen a behavioral problem for which the origins, treatment, and outcome have not been troubling.
  2. Mental illness, and, mental health, occur in context. They are products of the time and place they happen. Explain how a procedure like the prefrontal lobotomy could "fit" the historical moment. Desperation may have driven its origin and use, but, the same might well be said about current procedures that apply psychiatrc medications for which there can be serious, and/or, fatal outcomes. Take a degree of care in organizing your reply. While we are talking about history here, today's strategies will shortly be history subject to re-evaluation and criticsm.

Lesson 2 Discussion

If mental health, and mental illness occur in context, consider the meaning and effects a new and/or revised editions of the American Psychiatric Association's manuals on diagnosis and statistics has on the field. While they are not revised or issued annually, we now have the latest edition, DSM-Five, 2013, which is already raising questions about whether some changes from DSM-IV(TR), 2000, are really warranted.

The Veteran's Administration has had to look very hard at the diagnosis of post-traumatic stress disorder, which, at one point, was not even a diagnostic category! In order to deliver effective treatment, it is critical that a diagnosis matches a planned intervention. Changing times result in changing needs. Discuss this taking care to post your first response, and re-post to other students' replies.