HLTHAGE 2GG3 Past Paper PDF

WEEK 1 from madness to mental illness Mental health, illness, and modernity - WHO said that mental health is not the absence of disease and their new definition helped people actually pay attention to mental health Psy-disciplines and psy-complex - Psy-disciplines are psychiatry and psy...

WEEK 1 from madness to mental illness Mental health, illness, and modernity - WHO said that mental health is not the absence of disease and their new definition helped people actually pay attention to mental health Psy-disciplines and psy-complex - Psy-disciplines are psychiatry and psychology - Concerned w “the mental” and how to regulate it - Have grown in size and scope in last 150 years - Psy-complex refers to the tools and knowledge of psy-disciplines - Eg. conferences, journals, associations, institutions (they all help create psy-knowledge) - Psy-disciplines seep into other parts of life like the legal system and the education system Beyond healing - Critical theorists: psy-complex not merely about healing, but enforcing a certain type of social order through regulation and reinforcement - Psy-disciplines create the limits of behaviour that we deem acceptable/good - Impacts individuals, reflecting, reinforcing, and shaping particular social systems and norms This course - Examines the evolution of mental health/illness and how these ideas have been defined - Seeks to understand the functions served by the concepts of mental health/illness - Contemplates the roles that those responsible for mental health and illness (the psy disciplines) play in modern play - Considers the ways in which mental health and illness relate to broader social structures Pre 18th century - No concept of mental illness - it was madness - Still understood”absurd” behaviour and thinking - Range of explanations and responses - Thought to be due to head injury, from god, illness etc - Range of responses from compassion to mistreatment - Eg. bleeding and beating vs places of holiness for healing and compassion - Not Linked to medicine - Only sometimes understood biologically - Explained by many like spiritual healers, priests, etc - Not a doctor’s responsibility - Madness involved behaviors incomprehensive to others - Looked something like psychosis Vagrancy act 1714  - Old british law that differentiated “pauper lunatics” from “vagrants, sturdy beggars, rogues” - Britain was rly economically divided - Charged local authorities with apprehending lunatics and containing them with no treatment - Funded by taxpayers, this is a collective responsibility - Lunatics -> involuntary, against will - Start of forcible confinement bc of predicted dangerousness Rise of private madhouses - New law sparked “trade in lunacy” and rise of private madhouses - Turned to ppl who owned properties. They could apply to house “lunatics” in exchange for money - Created private money making enterprises - Custodial care: just keeping them away from others, no active care or treatment - Consequences: - Fear of confinement - Lunacy is subjective so high chance of wrongful confinement 1774 act for regulating madhouses - Required inspection and licensing of madhouses by royal college of physicians - Direct response - Shaped origins of psychiatry - Instead of letting random ppl house the mad, you have to get a license - Significant step in medicalizing madness bc they put doctors in charge of madhouses - If someone is going to be confined a physician and judge has to review case before confinement - Doctors now responsible for labelling madness - State is thinking abt all mad ppl being a state concern Enlightenment and modernity - The enlightenment marked by advances in philosophy and science - Celebration of reason, scientific optimism - New political philosophies highlighted individualism, liberalism, individual rights - Churches in britain began to lose power while science gained power - More belief in individual rights - Extended to madness - Madhouses could be therapeutic and actually treat madness Moral treatment - the york retreat - Beginning of modern psychiatry - Put them to ‘useful’ work on the land, selling produce ,etc - Approached madness with kindness Moral treatment i - philippe pinel  - ‘Therapeutic conversation’ could improve reasoning ability of mad, who were disconnected from reason - If treated with dignity, kindness, and discipline, the patient could recover their reason - Pinel went to madhouses and had the chains of the mad be removed - Discipline - providing structure for them but not punishment Moral treatment ii - rise of the treatment asylum - Jean-etienne esquirol (19th c.) - Dealing w madness requires special skills (psychiatrists) - He made idea of state ran madhouses (later became asylums) and they were built to be therapeutic to mad people - Called for purpose built asylums - Regimen itself therapeutic - New institutions to be placed away from cities Asylum building era - 19th c. move from few (privately run) madhouses to many massive state institutions resulted in explosion in patient population - Rise of new prossion, the alienist (old word for psychiatrist) - Ppl that dealt with ppl “alienated from reason” Legacy of asylums - Good intentions gone bad (too many people ended up confined) - No concrete improvements - Moral treatment gave way to custodianship - Some suggest psychiatry “lost touch” w medicine - In era of real advances like surgery and germ theory, psych seemed a bit hopeless Explanations - Foucault + social control - Rise of authoritarianism - Ppl got labelled as mentally ill when they did not adapt to new mode of living brought by enlightenment - Life dramatically altered by enlightenment and industrial revolution - New institutions are not for humanitarian care but rather control - An attempt to impose reason on the unreasonable Criticisms of social control theory - Romanticizes situation of the mad - Rise wasn’t abt social control, but rather that people were diverted from other institutions, like the poorhouse or prison Real rise in insanity? - Scholars claimed that bars and whorehouses increased mental illness  - Theories that they increased bc of dietary changes, alcohol consumption, disease, migration, etc Conclusions - 18th and 19th c. witnessed madness transformed into mental illness - Change was significant bc it brought a new profession, new ideas about who was mentally ill ,and a new infrastructure for identifying and responding to mental illness Scull - Psychiatry has been used as a tool by societies to control and manage deviance, with the rise of asylums and later developments in psychiatric practices reflecting changing attitudes toward mental illness and social order - Rapid industrial growth led to increased social problems like poverty, crime, and homelessness which set the stage for the expansion of psychiatry as a way to control populations considered problematic or deviant - The establishment of asylums was for treatment but also to isolate individuals deemed “insane” and to remove them from society - Early psychiatry was centered on moral treatment, which emphasized discipline, order, and work, to have patients adhere to social norms - Asylums became overcrowded and were more focused on confinement than therapy - Psychiatry created categories of mental illness, labeling individuals who did not conform to social norms as “insane” or “mad” - The asylums and psychiatric diagnoses helped maintain social order by separating those who were seen as threats to public decency and productivity - Behaviors that were attached to moral failings/sin because viewed as medical problems that required psychiatric intervention - Groups that were socially marginalized like poor, women, and ethnic minorities, were disproportionately targeted by psychiatric institutions - The 19th century was the rise of psychiatry as a profession and an increase of authority - Psych doctors were empowered to decide who should be confined in asylums, effectively giving them significant control over individuals’ lives and freedoms - 20th century was when criticisms began and there was a movement towards the closing of asylums and a transition to community based care - Scull said that deinstitutionalization did not always lead to better care because many patients ended up homeless or incarcerated - Drugs emerging created a shift in how mental illness was managed. While they were a therapeutic breakthrough, they also became tools for controlling symptoms and behaviour with address underlying societal issues - Penal psychiatry: as psych institutions declined, there was an overlap between psych and the criminal justice system where mentally ill ppl were managed through prisons rather than hospitals, reinforcing psychiatry;s role in controlling deviant behaviour - Scull argues that psychiatry has historically been used to manage individuals who deviated from accepted social norms - Through the establishment of asylum and the authority granted to psychiatric professionals, psychiatry became intertwined with the mechanisms of social control. This  dynamic continued even after the decline of asylums through new forms of psychiatric management like meds and outpatient care continued to regulate behaviour - Scull challenged the idea that psychiatrist main function has been the alleviation of suffering, because much of psychiatric practice has been more focused on controlling social disorder rather than the improving of lives of patients - Even in 20th cen. Psychiatric interventions were often coercive, with patients having little autonomy of choice in their treatments - Deinstitutionalization was intended to empower patients and provide better care in community settings but scull says that it failed many vulnerable populations. The lack of sufficient community resources led to a “revolving door” of patients between homelessness, hospitals, and jails - Psych drugs were presented as revolutionary treatments but they often served as control of behavior - Patients became dependent on medication Wright - In Between the 1800s and 1900s there were laws put in place to protect the ‘insane poor’ and these institutions created for them were overwhelmed with the amount of people within them - There were ppl who benefitted from this though bc of creation of jobs and need for psychiatrists - the connection between the increase of confinement of the insane and the emergence of the psychiatric profession is based on 4 assumptions - Medical superintendents played a role in the reasons for confinement - Medical officers have close to no power over comitance, however families have been observed to play a large role in whole is committed, because it is them who notice the behaviour and have them admitted, or they are sent to the workforce by family where their supervisors end up having them admitted - Individuals were incarcerated for very long periods of time bc of the incompetence of medical superintendents - Madness exclusively and unambiguously became defined as a medical illness - The asylum became society’s primary response to the problems of the mentally ill - Confinement of the insane was shaped by a complex interplay of social, familial, economic, nd institutional factors - Emphasis on the active role of families and communities in institutionalization decisions - Confining mentally ill ppl helped remove social disorder from public view - Industrialization and urbanization made families unable to care for the mentally ill, driving demand for asylum care - Asylum confinement is not completing coercive, there was consent from families and in some cases they were released back into the care of their families WEEK 2 emergence of the psyences (the organic school) Ppl always thought that madness is the result of psychological difficulty  - The scientific revolution and enlightenment prompted cultural shifts towards materialism and positivism - Materialism: Belief that all things including human consciousness have matter, they have a material form - Positivism: belief that all things can be discovered, faith that if you apply the scientific method all aspects of life can be understood explained and classified - Consequence is that the church lost authority, and science became the dominant social authority in explaining life On the eve of the 20th century - Born out of enlightenment - Psychiatry was in a challenging place bc asylums were overfilled which results in many problems like disease spreading easily - Little standardization, diverse theories/beliefs/practices/treatments - Psychiatry became marginalized The organic school - approach to mental illness that it is a physical problem that can be traced to the brain - Von krafft-ebing and the discovery of gpi - People figured that eventually with technology ppl would be able to trace mental illness to - Emil Kraepelin- peoples odd behaviours are traceable to specific diseases of the brain, he said that mental disorders each had its own cause, symptoms, and natural course and thus we could come up with logical treatments Heredity - ppl who argued that biology is the main source of mental illness looked at heredity which is the idea that Mental health problems are larger inherited - Lombroso: you could measure the skull and determine someone's mental illness or propensity for criminality - These ideas sparked anxieties towards decay and degeneracy which contributed to eugenics movement - Laws of eugenics can make it legal for psychiatrists to forcibly sterilize patients without knowledge or consent - T4 program (nazi germany) is example of eugenics where they tested their gas chambers on mentally ill people and used them to prevent mentally ill people from reproducing - Scientific racism Heroic treatments: fevers, comas, and shocks - malarial fever treatment was treating mentally ill people for general paresis with malaria - Ppl saw value in shocking patients out of psychosis - Sakel who would give people massive amounts of insulin and they would go into comas  - Meduna found a way to give people seizures with Cardiazol bc epilepsy and schizophrenia were not seen together in one person Psychosurgery - 1935, egaz moniz claimed incredible results for frontal lobe “leucotomy” which is surgery on the brain - Claimed drastic changes in behaviour - Therefore caused mindset on psych not being real discipline to change - Got nobel prize for this - Freeman introduced”transorbital lobotomy” - Knock away parts of frontal lobe - Went around a delivered lobotomies - Freeman lost license and lobotomies were banned bc he lobotomized 100000+ people and many died Controversies and legacies - Legacies are complicated - What does it mean for a treatment to work - Problem not of patient but also of practitioner - “Success” of treatment always up for debate - Power imbalances caused ethical issues - Doctors had power to kill patients for sake of science - Trust in “professionals” to make right decision - There’s no sense in mental illness, therefore no reason to listen to the insane - “Chemical imbalance” - Many holes in that thinking - Theory reflects “humanity as machine” thinking and idea of biologically needing certain number of neurotransmitters Psychopharmaceutical revolution - 1950s : we are currently living in world produced by this event - Development of thorazine - Chlorpromazine: quicker, safer, cheaper than heroic treatments - Developed accidentally bc it was found to create a calming feeling - “magical medicine” - Drugs worked so ppl believed MH is biological - Prompted other psychoactive drug experimentation - Ignited therapeutic optimism, seemed to promise end to asylums - Rather than being marketed as antipsychotics, they were called major tranquilizers Pharmaceuticalization  - Shaped how we understand being human - The belief of curing diseases instead of believing in alleviating symptoms of deficits - ES (excessive sleepiness) treated as disease to treat with drugs - Indications of psychopharm becoming wider spread - For many scholars, a more recent shift towards enhancement - Our baseline definition of normal and abnormal redefined by what can be treated - Drug comes before condition - Upswing in use of Rx (prescription) meds to manage ever widening dimensions of mental illness Pathways to pharma - Theories: - Cultural fetishization of science and technology - Almost like 2nd enlightenment - Optimism of all problems being resolved by med - Pressures and pace of modern life - Pace of life increased, desire to do the most in little time - Internet, capitalism, etc - Consumerism: post ww2 arrival of consumer capitalism - Implicit trust and faith in things that we can buy, hold, and consume - We can buy our way out of our problems - “Neutral” and “objective” clinical expertise inherently trusted Conclusions - Massive shifts in society that help to create notion of humans as machine - Organic school emphasis on disease and solution - Positioned suffering as individual problem that is resolved by bypassing the individual in favour of the organ of the brain - Focus on classification and insistence on symptomologies linked to specific diseases remain a central pillar of/barrier to treatment Braslow - Shift towards a clinical model with a focus on biological and pharmacological treatment of psychosis, leaving behind the psychodynamic approaches which emphasized unconscious processes and personal history - Mainly caused by rise of psychopharmacology and search for biological explanations of mental illness - In this new approach, psychosis was being treated as a purely biological problem, something to be managed with medication rather than understood as a meaningful experience for the patient - Antipsychotic drugs were seen as a way to manage psychotic symptoms outside of the hospital, which further depersonalized the treatment of mental illness  - Psychosis was stripped of its meaning when it went from a disorder that could be understood through the patients subjective experience, to a depersonalized, chemical imbalance that is corrected with drugs - This shift to a clinical, biomedical approach created a form of psychiatry that often neglected the emotional and personal needs of patients, focusing instead of efficient, control, and social management WEEK 3 Beyond the biological - From its origins, psychiatry divided between organicist and psychological/behavioural schools in terms of the nature and cause of mental illness - While some focused on somatic interventions to directly impact the body/brain, others saw potential in talk. For them problems were in the mind, not rly the brain - This uncertainty was crucial, as it allowed the scope of behaviors associated with mental illness to expand - If you only think about mental illness as a disease, it limits the scope - Without a clear dividing line between when healthiness stops and illness begins, psychiatry also began to weigh in on mental health - By mid 20th century, some argued that psychiatry needed to move beyond the individual, protecting the mental health of society as a whole Freud’s revolution - Not the first to talk abt unconscious processes (trained under charcot while studying) - To be human meant to have this hidden layer - psychoanalysis : both a theory and treatment - framed mental illness as result of unconscious conflicts between various parts of our mind (id, ego, superego), typically beginning in childhood - Id: part that is motivated by sex/aggression, impulse, wants what it wants, very hedonistic - Ego: mediates between id and superego - Superego: rules that act to stop us from acting upon impulses of id, morality, law, religion all internalized by superego - Not anti-biological! Focus on impulses rooted in assumptions evolutionary assumptions - Talking is a therapeutic technique that can bring unconscious feelings, thoughts, and actions to the surface - Dream analysis and free association (you could bypass the ego/superego by saying the first thing that comes to mind) - Heavy emphasis on childhood experience as genesis of mental troubles - By focusing on new feelings (neuroses) - and new patients - broadened focus on psychiatry, definitions of mental illness - Neuroses contrasted with the psychosis bc they are aware of the troubled feelings (eg. intrusive thoughts) unlike psychosis where they are unaware of the difference in reality Acceptance and resistance - Psychoanalysis became extremely popular and sparked an entire epistemological framework - Popularized among lay people - Dominates north american psychiatry - faced resistance and concerns over scientific rigour, morality, gender and sexuality, and accessibility Psychoanalysis in the 21st century - Psychoanalysis’ decline bc shifting economic ideologies have made psychoanalytic treatment unviable - Now its too expensive etc - Continued ascendency of positivistic thinking has challenged psychoanalytic-oriented therapy, despite patient satisfaction - In places where these socio-cultural trends are less pervasive, psychoanalysis remains far more visible - Others attempting to preserve psychoanalytic thinking - Scientification of psychoanalytic psychotherapy - Attempts to root psychoanalytic concepts in neuroscience through lab tests and trials to prove it works Psychoanalytic legacy - Psychoanalysis is the key to spreading of psy-disciplines and knowledge - Intensified belief that processes of the mind are knowable, changeable - The psy disciplines render human beings into something that can be known and classified - If we understand ourselves through a label, we live up to that label - There's a migration of psy knowledge out of the hospital and into the office which broaded the amount of people using psy knowledge - Another major change: before clinicians would assume that what came out of patients mouths was crazy jibberish, but freud said that there was some sense in what they had to say - Added another perspective where the patient is an important part of the treatment process - Psychoanalysis helped to create the idea that it was not just symptoms that needed to be helped, we need to work on the person themself Mental hygiene movement - Some clinicians suggested that if we want to cars for the mental health of ppl, we need to act at the level of society - This is like a public health approach where they try to prevent problems from ever happening - They opened centers and started programs to teach about mental health/illness - The moment social workers were brought into the psy disciplines WWII and the origins of social psychiatry - Fucked w the mental hygiene movement bc after WWII where it was caused by the negative effects of nationalism, population level mental health work became less encouraged - Post WWII, psychiatry shifted their mission to the prevention of conflict and creating stable democratic societies - Psychologists pushed ppl to be attentive to the psychological health of society - War revealed the general population was less mentally healthy than they thought - Concerns prompted recognition of “mental health” as a quality of all people, not just “mental illness” The social psychiatry movement - National Institute of Mental Health (NIMH) got established again after the war to fund studies that involve several tens of thousands of people to study social psychiatry, which suggested that mental health problems were verwhelmingly rooted in socioeconomic conditions - Psychiatrist mission expanded and clinicians argued its insights into the human condition could help society navigate era of massive changes and challenges - unemployment, race relations, industrial change, foreign policy, etc - New socpsychiatry movement called for a fusion of medicine and socsci - To prevent mental illness and protect mental health, necessary to go beyond medicine - Seeking for a way to diagnose society and create solutions to these problems - Their arguments are not rooted in science, but rather in the social world Decline of psychoanalysis and social psychiatry - Third wave said that the problem is not in the brain, it was in the structure of society - Psychoanalysis had a hard time providing concrete evidence demanded by a positivistic world that believes all things can be seen - Social psychiatry had evidence to support its claims, however governments were unwilling to act upon that evidence bc it would require massive social transformation - New socio-political currents, like neoliberalism, also made it harder for these to thrive bc they encouraged governments to be smaller and not interfere in peoples lives - Social psychiatry fell on deaf ears bc of these - New initiatives created a separation between treatment and care, leading to homelessness and trans-institutionalization - After DSM III, every diagnostic entity/disease has bullet point symptoms, and the biomedical model is being favoured Conclusion - Across 20th century, psy disciplines increased in scope and diversity - Psych and socwork both came to play significant roles in mental healthcare - Arrival of psychoanalysis WEEK 4 The cognitive shift and the happiness turn Into the 21st century - From “century of the psy-ences” to the 21st century they became entrenched in our daily lives - Terms from the field become more commonly used in expressions/ everyday conversations - Our surveillance of psychological play is increasingly carried out by laypeople (non specialists) - Example: tiktoks where people say things like “4 signs you have adhd” - Rather than taking these terms/ ideas out of the medical realm, its still thinking about it in a medical way, but it leaves out the specialists and lets laypeople take charge with these concepts - Emerging psy interest in enhancement, “maximizing human potential” - In 21st century psy disciplines leaned into the concept of science and marketed themselves as scientific disciplines Key questions - How can we explain the emergence of positive psychology and how has it impacted our notions of mental health? - How has positive psychology shaped everyday practices of mental health? - Where does positive psych and its offshoots fit into the broader story of psy-disciplines? - How has this shift A cognitive shift - Roots in early 20th century behaviourism, Cognitive Behavioural Therapy - Psychologists saw an issue with psychoanalysis where psychoanalytical stuff was impossible to show and prove - Give up on the intorspectic aspects and instead look at observable behaviour - They thought that behaviour can be observed, classified, and predicted - Behaviour is learned and we can use the process of learning to help someone who is suffering in a mental health care setting - Mid 20th century (1950s/60s): human behavior is filtered through thoughts - Ellis: distress is caused by what we think about an event - Eg. if someone gets in a car accident, asides from the physical hurt, they also have psychological suffering where they could develop a fear towards cars - Beck: automatic thoughts are identifiable and treatable. Through our experience, we learn what to think and how to think - Automatic thoughts (aka cognitive distortions) are developed through experience, like a child that is bullied that develops a self image where they are deserving of the bullying - If we want to treat people with issues like depression, we need to target these automatic thoughts  - Cognitive behaviour therapy emerged bc of emphasis on reshaping thoughts and it encourages scientific language Emergence of positive psychology - While cognitive behavioural theory is happening, Seligman has an epiphany in the garden - Was in the garden, and daughter came to talk to him and her responds angrily to her. She says that he’s a grump. He has epiphany where he makes an active choice to be a grump, and he can make an active choice to not be a grump to his daughter - He uses this epiphany to say that psychology has been largely focused on the negatives, when it can also be used to study what he calls “the universal science of happiness” - Csikszentmihayli: studied how people who have been through significantly psychologically damaging events live on to live strongly and happily - “Flow” : psycholigical state that people enter into when peopl are doing something they are so engrossed in that nothing else can interfere - Positive psychology emerges as the study of positive experiences, human strengths, and virtues Key tenets of positive psychology - Emotions are learned things that can be unlearned by addressing root thoughts/ cognitions. - Opposite of psychoanalysis where “bc we feel x, we have these thoughts” - Seligman: rather than curing “negative states, psych should augment individual's ability to prevent mental illness and foster good mental health - Positivity good for you, negativity bad. Happiness has a looping “multiplier effect”. If a person chooses to be positive, good things will happen to them, and if they choose negative, bad things - courage , optimism, faith, work ethic, hope, honesty, flow, and insight are buffers against mental illness - Wellbeing: positive emotion (the pleasant life), engagement (living in the present), finding meaning, having goals, and developing relationships Explosion of positive psychology - Important bc the media really pushed positive psychology - The “science of happiness”: optimism as good for virtually all aspects of life - Healing effect - Fredrickson: positivity undoes damage that negativity causes to cardio system - Segerstrom: positive thoughts boost the immune system Mindfulness - Started as a religious practice used by buddhist monks and spread to california in 60s and got simplified for mass consumption because of disconnect of culture  - Teachable technique to guard against mental health issues, increase life satisfaction, aid learning, etc - Part of the way mindfulness gets taught is that ppl need to be vigilant against thoughts that are “negative” - Scholarly critiques: - Reveley: when mindfulness says “you are in control of how you feel” he says that imparts self-responsibilization and it aligns with neoliberalism - Barker: despite it not using medicalized language/ practices, it tends to reinforce some of the baseline assumptions of medicalization that distress and discomfort need to be treated as an illness The happiness turn - Ahmed: said that we have started to think about happiness as if it is a concrete, real, desirable, measurable, definable thing - Sees this as suffocating, and that culturally we have taken on this perspective where we equate happiness with goodness - Idea that those who pursue the “right happiness” are rewarded and others are going to be punished - Right way: PP says that it is to pursue a particular set of practices and values like gratitude, being an optimist, always looking on the bright side - Wrong way: hookups, drugs, etc - Even if i like playing games and smoking weed and that makes me happy, its not considered the right way to pursue happiness - “Guilty pleasures” are a strange idea - This version of happiness reflects neoliberal stuff and social values and morals - Happiness is a choice that one makes Social critiques - Accountability: PP and mindfulness are rooted in the assumption that all people live a certain type of life - What makes this happiness possible is limited to ppl in those particular contexts - “Universal truths” about the “science of happiness” often grounded in culture of individualism, encouraging self-focus - Cabanas: happiness as the logical consequence of following the ‘science’ of happiness functions as a set of “ought to’s”. “If you’re not happy, the problem is you” - Binkley: says that PP reflects the neoliberal climate. When neoliberal thinking cemented itself into socio political thinking, one of the consequences of that was drastic cuts to social welfare provision, like tuition coverage cuts, disability cuts. Caused by idea that everything is up to the individual - “You need to protect yourself through your own actions instead of changing society and the circumstances you are in” Scientific critiques  - Perez-alvarez: PP uses the social capital of science to mask its underlying ideological character - We tend to think of science as facts, neutral, not involved in politics, but PP relies on those connotations we have towards science - Wilson: mindfulness uses the rhetoric of science to allow religious/philosophical ideas to invade secular spaces - Other critiques: a lot of PP is comprised of these logical fallacies - Tautologies (2 ways to say the same thing/circular argument): “those who are more satisfied in their life are happier” - PP selective in its logic, like saying automatic negative thoughts are baseless, but automatic positive thoughts are fine - Happiness is often presented as if it was something universal, identifiable, and measurable. This waters down and simplifies feelings Happiness as imperative - Held: the “tyranny of positive attitude”. Happiness is a must, and if you are not happy you are doing something wrong - Obscures the “benefits of the negative” - Wellness industry (gratitude boards n candles n stuff) often described as preying upon insecurities regarding being well, felt keenly since happiness is understood to be a requirement Conclusions - By 21st century, psy-disciplines focused on psyche as learned, rooted in cognitive frameworks, but we have the perspective to make a choice - Arrival of PP reinforces a vision of humanity where we can be easily categorized and measured - Happiness itself redefined from intangible and personal to definable, universal, and purchasable - By suggesting to us to make the rights choices etc, PP decontextualized us from the social world Barker - Mindfulness meditation has become a form of medicalization in western society - Critiques how mindfulness, which was originally a spiritual practice rooted in Buddhism have been repackaged as a self-help, medicalized tool for stress reduction and mental health management - Medicalization. Non-medical issues are being framed as medical problems and treated through medical means - Mindfulness meditation has become a popular remedy for things like anxiety, depression and stress - In a neoliberal context, ppl r encouraged to take responsibility for their own health and well being, and mindfulness is promoted as a diy tool - Mindfulness puts the burden of managing stress on the individual rather than addressing broader societal and structural issues like workplace stress  - In its westernized form, mindfulness is stripped of religious or philosophical elements and narrowly on its utility as a mental health intervention - Barker critiques the portrayal of mindfulness as a quick, easily accessible solution for deep psychological and social problems which can undermine the root causes of stress - Mindfulness contributes to self-regulation as a response to stress rather than critiquing the possible societal pressures that contribute to stress WEEK 5 The global mental health movement Globalizing mental health - 2007 Lancet (medical journal) editorial that called for a movement to “end mental health’s status as a secondary concern” called Global Mental Health - Mental disorders a substantial “through largely hidden” proportion of overall illness and disability burden - Mental illness is one of the principle causes of disability - About 3rd of population might qualify for mental illness/disorder - Need to put attention on issue of mental health and more funding/personnel - Movement brings together diverse actors to: - Improve mental health literacy, especially in Global South - Destigmatize mental illness - Ensure access to care across the world - Horton: - Key messages - Mental health is neglected and is connected with other conditions of global health importance - Resources for mental health are inadequate, insufficient, and inequitably distributed - There is evidence for a need to scale up mental health services - Low and middle income countries are not devoting enough resources to mental health - There are past examples of how critical it is to provide this support - Any call to action demands a clear sert of indicators to measure progress at country level Universal diseases or cultural formations? - Universalist: although content/framework might differ by place, same basic problems exist everywhere - Pushes the idea that mental illness is largely biological - Relativist: what counts as distress unique to any culture, as it inherently involves a violation of cultural norms - Despite disagreements, the universalist perspective has largely won out in the Global Mental Health movement Mental health in global south - GMH movement largely focused on mental illness in low income countries  - Key concerns: - Minimal spending on mental healthcare - 45% of world lives with less than 1 psychiatrist per 100,000 people - In global north, there's been a lean towards deinstitutionalization and outpatient, while in south they are dependent on psychiatric hospitals as the primary treatment - Stigma is prevalent in global south - Human rights violations - Untreated mental illness is hindering these societies from development - Saying that they are poorer countries because of underlying untreated mental health problems Addressing the gap - To address the gap between north and south, GMH tries to: - Develop international classification systems (like the DSM) and simplified tools for diagnostics - ICD (international classification of diseases) became standardized and is much like the DSM and is used by WHO - Standardize approaches to treatment (eg. through the “Essential Medicines” list, a list of medicines that every person in every country should have access to) - Push policymakers to give equal priority to mental health, arguing that tech (digital or pharmaceutical) can make up for low funding - Emphasize prophylactic measures (preventative measures) - Make up for psychiatric workers [GET NOTES] Case study: Latvia - Seen as a country that historically doesn't have a high degree of mental health care - Skultans: studied interaction between GMH push and Latvia - Local concept called Nervi (nerves) got displaced by global concept of depression - Nervi: somatized, grounded in relationship between individuals and societal disruption. Grounded in context - Depression: focused on individuals and their personal.internal world, including biology. Decontextualizes suffering - This new concept of depression being introduced to Latvian doctors caused the term to be regarded more as a folks term, and the doctors were encouraged to adopt the concept of depression - Enacted via professional groups (WHO, pharmaceutical industry) who went on the ground and basically acted as saviours and taught them the criteria for depression Critiques - Reframes social problems as individual issues - Eg. ADHD framed as barrier to development - GMH can be seen as part of a broader spread of neoliberalism’s individualistic logic  - Global mental health won’t work because it’s based on concepts that aren’t meaningful for those being treated - Eg. international trauma prevention programs - Community mental health services across Global South operate in isolation from communities they serve, disconnecting people from everyday realities - Focus on pill dispensing and compliance with global treatment standards rather than giving agency to people - Seeing mental health as something apart from everyday realities - Eg. im unhappy bc of my automatic thought patterns or serotonin levels etc - These luxuries may be unaffordable to those in some contexts - GMH as a form of psychiatric imperialism which basically is talking abt how its imposing its western values and biomedical models on non western cultures - Global south effectively prevented from contributing to knowledge production of this “global science” - Global mental health workers as the “new missionaries” modernizing, educating, civilizing - Talking abt how local populations “lack mental health literacy” assumes that they should think like us and that we don't need to understand their ideas - Culture framed as an obstacle - What is being globalized is not only a framework of understanding suffering, but also ideas about personhood: individualized, psychologized, on guard for personal failures and deficits, seeking to maximize personal potential Decolonizing mental health - Ppl who reject universalist approach have pushed against biological-reductionist perspectives - GMH names people’s experiences in alienating, technical terms that deny personal or social meaningfulness - Non-westerners at risk for involuntary, inappropriate, and harmful treatment - Calls for recognizing diversity in how people understand and alleviate suffering A century of the psyences - The GMH is an extension of the “century of the psy-ences” - Growth in size, scope, and importance of the psy-disciplines - A cultural transformation that sees classifying, labelling, and reshaping mental processes as central to individual and social development - Boom in population mental healthcare, as psy vocab and grammar have spread into every aspect of people's lives - Changed expectations, understanding, and the practice of being human WEEK 6 Esposito and perez: - Neoliberalism and market logic:  - Argues that neoliberalism, characterized by deregulation, privatization, and free-market emphasis, has transformed mental health care into a commodity - Mental health care is continually offered as products to be bought and sold - Mental health as a commodity - This shift causes more individualization of mental health issues, which are increasingly framed as personal problems rather than outcomes of bigger issues - Examples: - During the argentinian economic crisis, antidepressants were prescribed as a response to social distress, and doctors endorsed the use of SSRIs for the suffering caused by economic and political crises - Non western cultures (like argentina and latvia) historically understood mental distress through a social lens, but the global spread of neoliberalism has led to the adoption of the biomedical model and pharmaceutical solutions - Social alienation and control - Many people conform to market realities due to social alienation, leading to self-regulation and correction - Foucault + power: the market dictates acceptable behaviour, creating a system of unobstructive social control - medicalization/pharmaceuticalization of life - Pharmaceuticals promote an image of health and normalcy, regardless of risks which are disclosed as potential side effects - Pharma prioritize profit, sometimes as the expense of consumers’ health, which raises ethical concerns and demonstrates the strong influence of market forces on individual decision making - Psychotropic drugs and mental health - Some ppl argue that psychotropic drugs disrupt brain function which causes long terms effects - They offer short term solutions but long term effects - Addiction and consumer self - Critics link addiction to consumer culture, where happiness is tied to consumption - In mental health, this manifests as addiction to substances that offer fleeting relief - Psychiatric patients become lifelong consumers of drugs - ADHD stimulants are prescribed to children for poor academic performance, reflecting societal pressures to modify individuals rather than addressing systemic educational failings WEEK 8 The political use (and abuse) of psy Totalitarianism, the soviet context, the cold war - A very short history of the USSR - Ideological, utopian communist project - Emphasis on collectivism - “New man”, new citizens  - Political monopoly - Party as vanguard, locus on power - Repression - Authoritarianism totalitarianism - Cold war: global battle for ideological supremacy - Emergence of three blocs - “Fought” beyond military domains: diplomatic, scientific, athletic, etc Accusations of psychiatric abuse - 1971, Bukovsky’s dossier smuggled out to WPA (World Psychiatric Association), aired at the 1972 conference. Highlighted the “abuse of psychiatry” against dissidents - Politicized diagnostic practices: - “Split personality” (having interests in 2 unconnected fields like science and human rights work) - “Political mania” (being interested in politics and publicly speaking on them) - “Special hospitals”, inhumane conditions - Punitive treatments - Clinicians who questioned this practice were subjected to psychiatric abuse - Soviet refusal of accusations, rejected “politicization” of the mentally ill Soviet practices - Snezhnavsky, serbskii forensic institute, kashchenko hospital - “Sluggish schizophrenia” - Latent, slow acting, hard to detect - Fictional diagnosis used as a political tool to oppress dissenters - Described as having reformist delusions, bizarre perseverance, and failing to adapt to society - hundreds/thousands impacted - Dissenting psychiatrists ostracized, lost jobs, faced medical/legal persecution - Other east euro practices (hiding “troublemakers”) more common Pushback, expulsion campaign - By late 1970s accusations of political abuse of psychiatry were rampant - Psychiatric abuse was defined as the misuse of psychiatric diagnosis, treatment and detention for the purposes of obstructing the fundamental human rights of certain individuals and groups in a given society - Against backdrop of concerns over abuse, the WPA’s Hawaii Declaration (1983) codified psychiatric ethics - Cemented concepts like informed consent, patient confidentiality, etc - Saying that psychiatrists must never use profession power to violate dignity or human rights - Under pressure of expulsion, soviet delegation quit WPA Why psychiatry? Why psychiatry abuse? - If you call someone mentally ill, you are discrediting them Other examples - China - Tiananmen supporters (pro democracy) have also wound up being diagnosed with mental illness bc of their beliefs - Members of falun gong practitioners (cult) have been in hospitals - During cultural revolution 70% of patients admitted to shanghai hospital for “political reasons” - Munro: 3 forms of the political abuse of psychiatry - Overdiagnosis: when political non-conformity and “absence of instinct for self-preservation” acts as grounds for diagnosis - Underdiagnosis: when genuinely mentally ill held responsible for crimes that had a political dimension. not getting the diagnosis bc of political views - Withdrawal of services: some people withdrawn from psychiatric hospitals bc of their political views - genuinely ill - and imprisoned or sentenced to death - Despite initial change w/ fall of soviet union, its suggested that the practice has returned in some post-soviet states, including russia Complicating the concept - This this abt the profession or abt the political context - Van Voren suggested that authoritarian societies guided by a utopian ideology are more likely to be vulnerable, so leaning more towards political context - Expectations of conformity, buy in for collectivist project - “If you’re not with us, you are against us” - Someone important in soviet was famous for saying “ if you're not happy here, you must be mad” - Bonnie talks abt how authoritarian societies promote psychiatric abuse bc they r both prone to corruption, intolerance of dissent/deviance, and state intimidation endemic - Others say that actually, there's something abt psychiatry specifically that makes this possible - Diagnostic criteria always reflects the social context, what we define as mentally ill is a reflection of society's values - Some ppl say that soviet psychiatrists were not necessarily knowingly participating in abuse Beyond authoritarianism - “Political misuse” not limited to authoritarian contexts - Adorno and “the authoritarian personality” - Tried to understand what caused normal people to begin to fall for authoritarian leaders - 1960s: Magazine published survey from psychiatrists that deemed him unfit to run politically and it swayed voters - Led to adoption of “goldwater rule”: you cannot offer professional opinion of someone you have not personally spoke to/met without permission  - When trump first ran this got tested, ppl said fuck the rule, they should share their comments on trumps mental state or they are paving the way for totalitarianism - Others said that bc the discipline itself is inherently political, it must be constantly held in check. “Totalitarianism is built by degrees” Psy and the war on terror - Psy disciplines have been important cogs in waging the war on terror - Many people have been arguing that ppl who are terrorists are mentally ill - Ppl say that we can see the psychopathology of terrorists, they are irrational, mentally ill people - Ppl find methodological problems w this idea that they are mentally ill - They interviewed ppl that have been captured and tortured to determine that they are mentally ill but like. They literally went through torture so ofc they would display mentally ill behaviour - It's easy to just label terrorists mentally ill bc it lets us not think abt root causes of problems, or if their cause was justified - There's a tendency in the west to use mentally ill labels to discredit - Agarwal: psy disciplines were integral to the torture programs by governments - They redefined torture along medical lines to make them more acceptable, so some psychiatrists were torture consultants - They helped find ways to promote humiliation, carry out sleep deprivation, sexual harassment, etc - Military psychiatrists dismissed idea that detainees could have developed ptsd during torture bc otherwise theywouldnt be able to testify w their findings - Younis: the war on terror has drawn heavily upon psy knowledge and ideas to pursue “pre-crime” - Relies on the identification of individuals “at psychological risk of radicalization” - PREVENT detects these people by things like anger, rejection of foreign policy, distrust of media reporting, perceptions that government is discriminatory - Psychologization makes “radicalization knowable - The west shifts from a geographical location to a psychological category - Not anti [psychiatry - Western psychiatry comes in various diverse forms (like biopsychiatry) and is a local system of knowledge, meaning that it is only one of many ethno-psychiatries WEEK 9 Intro to psycho colonialism - Loomba: colonialism is the conquest and control of other people's land and goods - Both a historic process and a contemporary reality - Not just european practice - Post 16th c: This colonialism understood itself as a kind and helpful thing  - Colonial psychiatry is the establishment, administration, and practice of mental health care for both euro and indigenous populations in the context of colonialism Justifying the colonial project - Psy disciplines have generated knowledge and scientific facts that have helped to facilitate colonialism - Facts are context dependent (different contexts produce different facts) - Eg. idea that earth is flat is a fact for those who believe it - Participated in creation of racial stereotypes that helped cast europeans as saviours and the colonized as helpless - Fanon: part of french, became psychiatrist in algeria, quit his job as a psychiatrist to support algerians looking to overthrow the government because of his distaste for how his colleagues talked about north africans. These racist ideas were perpetrated by psychologists and psychiatrists - Gordon: african reasoning ability inherently inferior to europeans - Carothers: African mind “childlike”, incapable of handling the responsibility of democracy. Compared their frontal lobes to a leucotomy, therefore arguing for colonialism bc they needed to be guided by the colonizers - Within the americans, psy helped perpetuate “noble savage” idea - primitive, wild, uncorrupted by civilization - and they needed the helping hand of colonialism to guide them - Ernst: the construct of asylums in india contributed to painting the british as helpful, kind, superior, etc The psy-ences and slavery - Psy-disciplines facilitated slavery by reinforcing notion that some racial group’s natural state was one of servitude and inferiority - Cartwright - Drapetomania - This was a mental illness that could explain why slaves could run away from servitude - Saying that there was nothing wrong for slavery, they were just mentally ill so they wanted to run away - Cure proposed: good food/clothing, limited social interaction - Dysaethesia aethiopica - Commenting on slaves who broke farm equipment/machinery etc, and rather than seeing as a protest to the unjust conditions that the slaves lived in, he saw it as a mental illness acting up Constructing race - Psy has participated in the construction of the race concept itself - Vaughn: talked abt how psy disciplines contributed to colonialism through its framing of the ‘normal mind’ of africans, rather than the pathological one - Colonial psy has tended to approach colonized patients not as individuals, but as racial stereotypes, which helped build notion of racial differences  - Residential schools logic is that there is a race based mindset which could be destroyed and changed - In algeria, Kocher (psychiatrist) talked abt how if u look at muslim mind, violence in inherent, and suggested that is they could be made to be more french, it would solve this - Kennedy: “tropical neurasthenia” as being rooted in how “actinic rays” - “more intense in tropical than temperate zones” - penetrated the white skin of settlers, but not the darker skin of natives - Hats were made to keep out “actinic rays” ??? but understood as scientific fact at the time Facilitating colonialism - Psy world important to the bureaucratic machine of colonialism bc they provide a system to categorize and classify people - Kloos: psy disciplines help to create idea that colonial authorities had control when often they didn’t - By producing assessments on “indigenous psychologies,” psy-disciplines conferred an imagined rationality, further justifying the ‘civilizing mission’ - These typologies provide rationale for intensified colonial violence - In algeria, there's a mixed population of several groups, and some colonialists created profiles of these groups in a bad way, and then colonialism became justified, bc they need to be subjected to the violent treatment Native madness - While the “normal psych” of indigenous population received most attention, colonial psych also grabbed w/ mental illness among locals - Psy argued that mental illness was comparatively rare among native populations, owing to “simplicity” - - Assumption was that most native populations didn't experience mental illness frequently - Carothers: positioned a rebellion against colonialism as people in kenya had gone mad and should only be understood as a few people that went insane - Mau mau - While some mad locals treated in asylums, most continued to receive traditional care Protecting the colonizer - Colonial psychiatry also extended to the settler population - Ernst: diagnoses of British worked to uphold image of superiority. Those whose behaviour threatened this image repatriated - Someone who became mentally ill proved the lie abt superiority - ‘Going native’ a cause of concern: seen as a sign of insanity and a cause for madness - If they married someone indigenous, took up the dress, diet, or practices they were ‘going native’  - Explanations for madness among settlers frequently noted the dangers that “primitive environments” posed for “civilized peoples” - Kennedy: an environment where there was an isolation from modernity was seen as psychically disorienting and destructive. An individual who is used to a ‘higher’ life cannot be brought down to the level of ‘savages’ so they need to be isolated from them Differences in care - Racial ordering maintained even within colonial asylums - In india, full segregation, better facilities for europeans, hard labour only for indians, etc - Asylums were new and were built to represent their modernity and betterness - Often differences in treatment: euro got psychological focus while indigenous got somatic treatment - Euro considered smarter than indg so they figured indg wouldn't be smart enough for psych treatment to be effective - With little psych resources, they weren;t going to waste these resources on a group they consider inferior - Sandowsky: in nigeria 1950s, no treatment for locals. No difference between prison and asylum - Swartz: black people more likely than white people to die of infectious diseases bc of differences in asylum housing - Within canada, indg patients sterilized without consent under eugenics laws at a higher rate - Case study: leilani muir Suppressing dissent - Psy played an important role by framing resistance as insanity - In DSM, until DSM4, there was a diagnosis called ‘arctic hysteria’, under culture bound syndromes which are known only within specific culture groups - When european psychologists encountered behaviour that they didn't recognize, their tendency was to assign a label rather than think of things from the perspective of the person (ethnocentrism) - Kloos: “atjeh-moorden” blamed on ‘primordial’ character of Acehnese and their tendency to insanity - Amok translated from a collective call to violent resistance into a ‘solitary’ and ‘irrational’ culture bound syndrome (where the phrase run amok came from) - Swartz: those who disrupted economic order subject to clinical attention and treatment - As care was carceral, added “benefit” of removing agitators - In doing so, psy disciplines positioned madness as individual pathology, rather than a reflection of the colonial context - People operate within broader systems and dont interrogate these systems Contemporary manifestations - Indg individuals still overrepresented in mental healthcare system  - The modern ‘suicide’ crisis - People call for more mental healthcare resources for them, but this is individualizing the social problem that is colonialism - Intergenerational trauma is imagined as a thing that a person has/ it resides in that individual, but its a result of colonialism - Mcgibbon: psychiatrization is a mechanism of the apparatus of modern day oppression - Loads responsibility onto the person - We never get to the root of the issue Colonialism as a psychological project - Psychological dimensions of colonialism - Inferiority, shame, inefficacy - Colonizer culture and practice as superior, modern, dignified - Assimilation not possible, at best ‘third class’ status achievable - Quijano: ‘colonization of the imagination’ persists: coloniality Conclusions - No such thing as value-neutral, culture free psychology - Human sciences always reflect the socio-cultural setting of those that set the disciplines’ norms and standards - The psy disciplines have a super critical role in defining normality WEEK 10 identity, marginalization, and the psy-ences Constructing gender - Psy-disciplines central to the articulation of gender norms - Pp argue that femininity has been crafted through the psy-gaze - Hysteria: from ‘roaming uterus’ to ‘constitutional weakness’ and ‘somatic unpredictability’ - Shifting symptomology reflected ‘ unpredictable nature’ of women’s bodies - Dramatic medical metaphor for everything men found mysterious or unmanageable in women - Psychoanalysis is heavily gendered - ‘Conditions’ treated by minor tranqs amidst the valium panic - BPD regarded as ‘shorthand for difficult, angry, female client’ - The ideology of a masculinist society dressed up as objective truth Case study: female sexual dysfunction - Female orgasmic disorder - ‘Any difficulty or delay is orgasm that causes the woman personal distress’ - Diagnosable if a woman doesnt orgasm from ‘sufficient stimulation’ - Sexual interest/arousal disorder - Us data: 32% of women ‘have it’, more than 2x the rate of men - Symptoms include discrepancies in desire and being typically unreceptive to a partners attempts to initiate  - Lack of receptivity not included in male equivalent - Through defining these ‘abnormal women’ what does that imply about ‘normal’ women? Diagnostics and treatment - With non-immediately observable complaints, MDs are more likely to assume that men’s problems are organic, while women’s problems are psychosomatic - Women are less likely to receive advanced diagnostic and therapeutic interventions, more likely to receive Rxs (prescriptions) - In both instances, notions of women as irrational reinforced Functions - Symptoms and causes of women’s mental health problems typically reflect underlying ideas about gender, especially the behaviors ‘appropriate’ for women - Gender norms (and violation) linked to mental health/illness - Some cases might better be understood as a form of resistance against gender norms - Psy disciplines may simultaneously ‘pathologize and protect’ women - Tendencies to somatize women’s mental health may reinforce conceptualization of female bodies as flawed, unpredictable - Reinforcement of crude stereotypes abt women as overly emotional or irrational Queer and trans encounters w/ psy - Psychoanalysis was dominant within na psych until the 70s, and was a heavily gendered theory - Rooted in heteronormativity - Framed homophobia as the fear of the opposite sex - Homosexuality delisted in 1973 in DSM, replaced for a while as “Ego-dystonic sexuality” until 1980s (in ICD until 1990) - Gender identity disorder first in DSM III - DSM IV: “Boys who want to wear dresses, or girls who refuse to” - Boys 6x more likely than girls to be diagnosed bc of a slightly more normalcy of tomboys - DSM V: term changed to gender dysphoria - Gender nonconformity is not a mental disorder, the critical element is the presence of clinically significant distress, not rooted in societal attitudes - Some people dislike it being considered a mental disorder that isnt influenced by society, but some people argue that its a necessary tool to get gender affirming care Care and harm - historically, psy practitioners have attempted to treat queer/trans ppl via transformation - From 1950s, aversion therapy including both somatic (things like show a person the wrong kind of porn and have them take a drug that would induce vomiting or shock them to form a negative association with gay stuff) and psych/behav dimensions (psycho education, explaining to the person why homsexuality is bad) - Aka conversion therapy - Treatment often rooted in moral universe Race, class, and psy world  - We sometimes have a dangerous tendency to imagine that science amoral or apolitical, but this isn’t true, especially when the topic of study is human behaviour/studies - In british psych hospitals, black individuals 21% of patient population, but only 7% of general population - Black people are more likely to be admitted than white - Race and class both structure likelihood of receiving particular diagnoses - Working class mental health problems more likely to be rated severe than higher class - Black and working class people less likely to be referred for psychotherapy - When a person's problems are described in diagnostic terms, one of the unintentional outcomes of it is that we don't try to address root causes The “protest psychosis” - Metzl: Author looked through patient records for a lot of hospitals in michigan, and found that profile of ppl who has schizophrenia changed from a petty criminal, non violent white people, until 1960s - In 1970s profile changed to masculinized black belligerence - Civil rights movement at the time - Shift is diagnostic criteria to include “aggression and hostility” Lass, violence, and social causation - Psy disciplines have spent time trying to push back against idea that mental illness prompts violence - 2 exceptions - Person been diagnosed with schizophrenia and deal with paranoia - Person diagnosed with addiction - Arguments that we r misreading the situation, and that its the social circumstances of these people that are the catalyst for the mental health problem and violence, but it might not be causing the violence directly - People who are poor are more likely to feel a lack of control in their life, which can lead to a higher likelihood of commit acts of violence - When people enjoy social supports and less economic hardship, they are not significantly more likely that general population, to commit violence, even if diagnosed w/ “high risk” disorders Homelessness - Most ppl have idea that people who have really significant psych problems are more likely to be homeless than the general population - Socio economic ladder - Deinstitutionalization: we lost 85% of hospital capacity so many of the people who were in the hospitals wound up homeless - Third possibility: mental health problems that homeless people experience are a product of homelessness itself, so the state caused the mental illness - Many homeless people who are mentally ill cycle through the “institutional circuit”, w/ failure to settle typically explained w/ reference to illness rather than state of services - Stops us from thinking about what's going on when people get diagnosed bc the illness explains all behaviour Sci and psy  - What makes psy proclamations so meaningful is the way that they draw upon cultural capital of science - Beliefs abt the objective nature of medical diagnosis disguise the fact that clinical practice is always embedded in a social context - May prompt a broader refusal to recognize the possibility that bias may exist within scientific practice - Through their activities the psy disciplines may inadvertently contribute to marginalization through: - The establishment of ‘norms’, which both pathologize those outside of the norms, and fosters beliefs abt ‘healthy’ groups that may be harmful - Via treatment w/the aim of ‘restoring normality’ - Via psychiatrization, which encourages us to individualize social problems WEEK 11: institutions Asylums revisited - 19th c. rise of public institutions - Part of broader ‘progressive’ reforms that “degenerate, disabled, criminalistic, or uncivilized peoples can be brought up to normative standards” - Theoretically any person was now capable of achieving normalcy - Social control critique: reflected broader belief that individuals could be tutored for “responsibilities of economic freedom” - Belief that hospitals should be governed by discipline and scheduling - The culture shifted coming out of the enlightenment towards an intense individualism, which has been in place since this time - Tried to turn people into ones that fit into this economic, logical system - Belief that hospitals should be governed by discipline and scheduling - Those who could not be tutored were ushered into custodial care (and patient population boomed) - Other goals of moral treatment failed (patient programming, restraints) Total institutions - Created by goffman who spent time within psych hospitals and created book ‘asylums’ and defined a total inst as a closed circuit, a world itself disconnected by society and the logic and rules that govern society - Authority within these institutions exert tremendous power over those who live within them - These people must follow preset schedules with little choice or privacy - These people become stripped of their identity - Involves a ‘mortification of the self’ replaced by an institutional identity Criticism of institutionalization - Costly: jfk said bc ppl rarely improved and bc of books that highlighted the actual conditions of how people were living within institutions, people were losing faith in how much it costed - Ineffective: too many long term stays in hospital, and too many failures after getting out  - Inhumane Deinstitutionalization - Aimed at closing down psych hospitals, tightening laws - 1963: Community Mental Health Act made involuntary confinement more difficult, which led to a rapid drop in inpatient population - 1960-1980: from 70k to 20k in canada Homelessness and mental illness - The traditional explanation: w/o community supports, more mentally ill on the streets - Either bc mental illness means they cannot support themselves or “institutional neurosis” (way of describing the changes that unfolded within a person who spent a lot of time living within a psychiatric institution) - Critics say that its not simply bc of hospital closure, but also decimation of the welfare state - Welfare state refers to all of these initiatives and policies that redistribute wealth in society that is aimed in a way that improves general welfare - Poverty and homelessness drive mental illness, rather than the reverse. Mental illness is a simple explanation for the complex problem of homelessness - Implies that the solution is more treatment - Some people are pushing for deinstitutionalization bc of the homelessness problem - Reflects tendency to individualize suffering as a personal problem rather than a social one Residential care facilities (RCFs) - After deinstitutionalization, RCFs became a common form of care in the community - Typically privately-run, financed w/ public funds. Owners must be licensed - Critiques echo the “trade in lunacy” - Poor conditions - Individuals frequently must pay a substantial portion of disability benefits to cover care, making it difficult to meet other needs - Incentivized to cut corners to maximize profit - They still have to pay rent through things like funds or welfare, and they end up left with very little money - Insufficiently educated, underpaid staff - They become sites of various social problems since residents are highly vulnerable Prisons and mental illness - Prisons house most mentally ill in NA - compared to most institutions - Inmates often get diagnosed - US: 15-25% of prison population has ‘severe mental illness’ and 50% have some kind of diagnosis - Canada: almost 15% of prison population diagnosed w schizophrenia or bipolar disorder - Possibly a consequence of trans-institutionalization - Indicative of growth of the ‘psy-complex’ - Psychology is everywhere, we think of ourselves as psychological creatures  - Changes the way we think of individuals who are incarcerated, not just criminals, but mentally ill Within prisons - Compared to non-diagnosed, mentally ill prison population stays longer, more frequently suffers violence, and has higher suicide rates - Despite legal right to same healthcare as non-incarcerated, services are restricted, usually limited to acute crisis - Bc inmates cannot cope in ‘normal’ prison setting, segregation is used, thus causing: - Feelings of alienation but worse bc they’re already in prison - Think of ppl incarcerated who already have some issues - Putting them in prison makes it worse bc they are more exposed to violence - Actively harming mental health Is this abt crime? - Bc we closed psychiatric hospitals, are we putting the mentally ill in prison, or are we taking criminal behaviors and medicalizing it? - Many behaviors now imagined as ‘sin’ - 60-80% of prison population has antisocial personality disorder - Likely just a label on bad behaviour - Indicative of trend to expect psy to explain all aspects of the human condition - Pedophilia being framed as an illness rids agency/responsibility - A double-bind: tendency to blame criminality on mental illness, but prisons fail to meaningfully address mental health issues Case study: Ashley Smith - Brought into criminal justice system at 15, diagnosed w BPD bc she was throwing crab apple at postal worker - While in custody her sentence was extended 4 years for fighting w guards, and during 4 years she typically spent 23h per day in segregation and was subject to force on 150+ occasions - She was given nothing, no books, writing utensils, clothes or shoes except for a smock, no mattress, no blanket and was forced to sleep on the floor all to stop her from killing herself - Forced into restraint chair bc she was bashing her head into the wall - Died at 19 by suicide but wa slater determined to be homicide bc prison staff were ordered not to remove the ligature she used to choke herself as long as she was still breathing - Upon admission it was said to be treated as a mental health case but the conditions of the prison worsened her Beyond brick and mortar - UN committee in the Rights of Persons w Disabilities’ definition of institutions - Obligatory sharing of assistance with others, with lack of choice and control over who provides assistance, day to day decisions, and with whom a person lives - Rigidity of routine, irrespective of personal will/preferences - Supervision of living arrangements - Isolation and segregation from independent life in the community  - Beyond formal institutions, many scholars note that aspects of ‘care in the community’ may also meet much of this criteria Why do institutions persist? - People need care, and institutions provide access to treatment, form of housing, protection for vulnerable populations, respite for caregivers, secure setting for involuntary, assaultive patients - There are far less humane reasons for their persistence, including ‘institutional archipelago; of confinement and control, ‘medical industrial complex’, and solutions to the ‘eyesore’ of mentally ill/homeless population