PHL383 Exam Study Guide PDF

PHL383 Final Exam Study Guide Summary of major takeaways Highlight overarching themes, patterns, and connections S1: Bioethics and/of mental health (Sept 06) LECTURE NOTES Summary Different approaches to b...

PHL383 Final Exam Study Guide Summary of major takeaways Highlight overarching themes, patterns, and connections S1: Bioethics and/of mental health (Sept 06) LECTURE NOTES Summary Different approaches to bioethics, contrasting "top-down" theoretical frameworks with "bottom-up" case-based methods, advocating for a "reflective equilibrium" approach. A significant portion examines the historical context of mental health institutions, highlighting ethical implications of past practices Key Points/Concepts Approaches to Bioethics Top-down: start with general theories ○ Critique: can be too general for practical guidance; theories may come in conflict with each other; irrelevant Bottom-up: start with particular circumstances ○ Critique: difficulty deciding which details are relevant; concerns with managing novel cases Reflective equilibrium: aims to match judgments with beliefs to render them coherent and then test the results Historical Context and “Brick Walls” History of Institutionalization: transition from asylums to modern mental health centers ○ Ex. the “Ayxiliary Female Asylum” → now part of CAMH ○ Ex. the “Provincial Lunatic Asylum” → later evolved into CAMH Gendered and Racialized Practices The Andrew Mercer Reformatory for Women Velma Demerson arrested for her interracial relationship Muriel Walker arrested for becoming pregnant out of wedlock Patient labor within institutions, like “May F.” and “Audrey B.” being forced to work in the asylum Exclusionary Practices Ex. Ugly Laws and Anti-vagrancy Laws How social norms enforced by marginalizing ppl who deviated from norms of appearance or behaviour Key Terms/Definitions Bioethics: The study of ethical issues arising from advances in biology, medicine, and related sciences. Top-down approach to bioethics: An approach that applies broad, overarching  S1: Bioethics and/of mental health (Sept 06) ethical principles or theories to specific situations in bioethics. Bottom-up approach to bioethics: An approach that begins with specific details and circumstances of a case, building towards broader ethical considerations. Reflective Equilibrium: A method of moral reasoning in which one revises and adjusts one's beliefs, principles, and judgments in order to achieve coherence. Moral Therapy: An approach to the treatment of mental illness that emphasizes structured daily routines, work activities, and positive social interactions, though this concept has historically been abused. Multidisciplinary: Involving several different academic disciplines. Interdisciplinary: Involving an integration of several different academic disciplines to gain a better understanding of a topic. Medicalization: The process by which non-medical problems become defined and treated as medical conditions. Exclusion Criterion: A factor that would rule out a potential diagnosis, suggesting the presence of an alternative explanation for the symptoms. "Ugly Laws": Laws that targeted and marginalized individuals who were perceived as having physical disabilities or disfigurements. Anti-vagrancy Laws: Laws designed to target and marginalize the poor, homeless, and other individuals who were deemed to be "out of place" or not conforming to social norms. Normative Ethical Theories: Theories that attempt to establish a standard of right and wrong conduct, forming a basis for moral judgments and actions. Principleism: A bioethical approach that relies on principles such as autonomy, beneficence, non-maleficence, and justice to guide ethical decision-making. "Ought Implies Can": A moral principle stating that we are only obligated to do what is within our power to do. Questions for Review What is the key difference between "top-down" and "bottom-up" approaches to bioethics, as discussed in the lecture? Explain why the lecture argues that legal considerations are distinct from moral claims. What is "reflective equilibrium," and how is it intended to be used in bioethics? According to the lecture, why is the history of institutions like the "Provincial Lunatic Asylum" relevant for contemporary bioethics? How does the lecture frame the discipline of bioethics in terms of "conversation"? Describe the concept of "moral therapy" as it was used at the Provincial Lunatic Asylum, including an example of how it manifested. How did "ugly laws" and "anti-vagrancy laws" function to marginalize certain populations? How does the removal of the bereavement exclusion criterion from the  S1: Bioethics and/of mental health (Sept 06) DSM-5 for major depressive disorder illustrate the course's themes about the medicalization of everyday life? What is the primary focus of the course's assignments, and how does that relate to the stated learning objectives? S2: The "mental" in mental health (Sept 13) LECTURE NOTES Summary Perspectives on mental health from different disciplinary and activist traditions Relationships between minds, bodies, and the environment Learning Objectives (1) survey some common philosophical approaches to defining mental health (2) interrogate some of the assumptions of those approaches (3) reflect on what these differences in approaches might entail for differences in how we do bioethics (4) to start asking questions about some of the diagnoses outlined in the DSM in particular, which we'll look at more in later weeks. Context for why topic is Helps us understand complexities of mental disorders important Key Points/Concepts Approaches to defining mental disorders 1. Conceptual: examining existing concepts and what we mean when talking about mental disorders 2. Descriptive: identifying what mental disorders are in the world 3. Ameliorative: goals we want our definitions of mental disorders to achieve Degrees of understanding: 1. Clarity: identify and recognize a concept (ex. Recognizing a mental order) 2. Distinctness: defining and explaining a concept 3. Pragmatic: practical implications and effects of a concept The Mind-Body Problem: 1. Cartesian Substance Dualism: mind and body are separate a. Responses: everything (incl. The mind) is reducible to physical stuff + ability to imagine oneself separate from the body is influenced by social position J.J.C Smart and Charles Mills’ Responses to Cartesian Substance Dualism: J.J.C Smart: everything previously thought to be non-physical has been proven  S2: The "mental" in mental health (Sept 13) to be reducible to physical matter (e.g. lightning) ○ Mind is an exception and will be proven to be physical as well Charles Mills: argues Descartes’ ability to conceive of himself existing without a body is related to his social position ○ Descartes’ sense of self isn’t reduced to physical form due to factors like social status and lack of experiences with racist violence and exploitative labour (can cause person to be reduced to their body) ○ Social and historical circumstances shape notion of the mind Language and Terminology Historical weight of language in bioethics Need for sensitivity, self-correction, and reflection Historical Context Distinction between “-iatry” (medical practice) and “-ology” (branch of science) ← distinction btw psychiatry and psychology Content from the readings Minimal vs strong model: ○ Minimal model: observable symptoms (syndrome) ○ Strong model: underlying causes of mental disorders Need to incorporate the phenomenology of illness (i.e. lived experience) into our understanding Embodiment: Mental illnesses are embodied experiences Body not absent or separate from cognition ○ Illness draws our attention back to body Health: “life lived in the silence of the organs” ○ Manifests by escaping our attention Cases for Discussion: what makes something a mental disorder? Should built environments be considered? 1. Premenstrual Dysphoric Disorder 2. Pica 3. Pseudocyesis 4. Anorexia Nervosa 5. PTSD Important quotes and Sally Haslanger (2012) - “Gender and Race: (What) Are They? (What) Do We References Want Them to Be?” ○ Three approaches to defining “mental disorder”: conceptual, descriptive, ameliorative  S2: The "mental" in mental health (Sept 13) C.S. Peirce (1878) - “How to Make Our Ideas Clear” ○ Degrees of understanding: clarity, distinctness, pragmatic ○ Pragmatic considerations Rene Leriche (1936): ○ Quote: “Health is life lived in the silence of the organs” ○ Meaning: health is often unnoticed, and only when something goes wrong, do we become aware of our bodies Hans-Georg Gadamer (1990): ○ Quote: "Health is not something that is revealed through investigation but rather something that manifests itself precisely by virtue of escaping our attention" ○ Meaning: supports idea that health is often invisible and only through its absence that we can perceive it Key Terms/Definitions Conceptual Approach: examining existing concepts and what we mean when talking about mental disorders Descriptive Approach: identifying what mental disorders are in the world Ameliorative Approach: goals we want our definitions of mental disorders to achieve Clarity: identify and recognize a concept (ex. Recognizing a mental order) Distinctness: defining and explaining a concept Pragmatic: practical implications and effects of a concept Cartesian Substance Dualism: mind and body are separate Minimal Model: observable symptoms (syndrome) Strong Model: underlying causes of mental disorders → unify symptoms and justify their classification as syndromes Phenomenology of Illness: lived experience of illness ○ Subjective, experiential aspects of illness and how these experiences shape our understanding and navigation of illness Syndromes: collection of symptoms that are observed and recognized in the minimal model -iatry: suffix denoting medical practice or treatment ○ Ex. podiatry, pediatrics, psychiatry -ology: suffix denoting branch of science or knowledge ○ Ex. biology, geology, psychology Questions for Review What are the three approaches to defining "mental disorder" according to Sally Haslanger? How do the conceptual, descriptive, and ameliorative approaches differ from each other? According to C.S. Peirce, what are the three degrees of understanding a concept? How do clarity, distinctness, and the pragmatic aspects of a concept  S2: The "mental" in mental health (Sept 13) contribute to understanding it? What is the pragmatic aspect of understanding, and how might it be applied in the context of mental disorders? What is Cartesian substance dualism and how does it distinguish between the mind and the body? How do responses to Cartesian substance dualism, such as those by J.J.C Smart and Charles Mills, challenge the idea that the mind is separate from the body? How might one's social position influence their view of the relationship between mind and body? Why is it important to be mindful of the language used when discussing mental health? How can the provided scripts help us engage in respectful dialogue? What is the difference between the suffixes "-iatry" and "-ology," and how do these relate to psychiatry and psychology? What perspectives might be missed when focusing on specific lineages and institutions? What is the difference between the minimal and strong models for understanding mental disorders? What are the limitations of the biomedical model in explaining mental illness? How does the phenomenology of illness contribute to our understanding of mental disorders? What does it mean to say that mental illnesses are embodied experiences? How can our bodies disappear from our awareness, and how does illness draw attention back to the body? What kinds of questions might one ask when considering specific cases, such as Premenstrual Dysphoric Disorder, Pica, Pseudocyesis, Anorexia Nervosa, or PTSD? How might we use these cases to reflect on the role of the environment in the diagnosis of mental disorders? Dominic Murphy (2020) "The Medical Model and its Implications": Sections 2-2.3 Summary Section 2.0: medical model of psychiatry and implication Distinction btw minimal and strong interpretations Section 2.1: minimal interpretation (mental disorders viewed as clusters of co-occurring symptoms w/o committing to underlying physical causes) Section 2.2: DSM’s syndrome-based approach Aligns with minimal model  S2: The "mental" in mental health (Sept 13) Critique that it neglects causal structure and groups heterogeneous conditions Section 2.3: strong interpretation of medical model Explains mental illnesses through specific causal hypotheses about pathogenic processes in brain systems Key Points/Concepts Q. How do Murphy’s interpretations influence our understanding of the “mental”? A. Section 2: The Medical Model and its Implications Psychiatry largely adheres to the medical model: applies medical thinking and methods to the study and treatment of mental illness Two main interpretations of the medical model: ○ Minimal interpretation ○ Strong interpretation Medical model suggests that mental illness is rooted in the body (esp. The brain) ○ The degree to which it focuses on underlying biological mechanisms varies significantly between the minimal and strong interpretations Section 2.1: The Minimal Interpretation Minimal interpretation of the medical model: mental disorders are observable, regularly occurring collections of symptoms (syndromes) that unfold in characteristic ways ○ Observable phenomena as basis for classification and diagnosis: signs, symptoms, course of illness Theorists: ○ Kraepelin: used minimal interpretation to differentiate between diff forms of insanity based on symptomatic presentations DSM’s syndrome-based classification in line with minimal interpretation Diagnostic labels are useful tools for identifying and grouping sets of symptoms Section 2.2: The DSM Conception of Mental Illness and Its Critics How the DSM reflects the minimal interpretation of the medical model ○ Treats mental disorders as syndromes/clusters of co-occurring symptoms that unfold over time Individuals with same DSM diagnosis may have different combinations of symptoms ○ DSM lacks specific causal hypotheses DSM is a practical system designed to improve communication, education, and research Key criticism of DSM: ○ Emphasis on observable symptoms without corresponding causal S2: The "mental" in mental health (Sept 13) explanations → grouping of heterogeneous conditions (i.e. diff underlying causes) w similar symptoms Reliability vs validity: ○ Reliability: agreement across measurements and observers ○ Validity: measuring something real Philosophical challenges to idea that science can uncover true nature of mental illness + concern validation only shows link btw behaviour and physical process and not the pathology of behaviour Point of contention: DSM’s treatment of grief as an exception to diagnosis of Major Depressive Disorder ○ Pathologizes normal human reactions Section 2.3: The Strong Interpretation of the Medical Model Strong interpretation of the medical model: mental illnesses aren’t just symptom clusters, but pathogenic processes in underlying neurobiological systems ○ Causal mechanisms and processes within the brain ○ Psychiatry should embrace practices of medical explanation by identifying pathological processes ○ Causes of mental illness found in biological and environmental factors Must understand normal function of brain to identify and explain abnormalities that result in mental illness Debate over whether background theory for psychiatry should be cognitive neuroscience or molecular biology Manipulationist approach to causation: a cause is identified through intervention and manipulation of variables  S2: The "mental" in mental health (Sept 13) Questions for Review What is the "medical model" in the context of psychiatry, and what is its significance according to the source material? What are the two main interpretations of the medical model, and how do they differ in their approach to mental illness? According to the minimal interpretation, how are mental disorders defined and classified? What does it mean to say that this approach views diagnostic labels as useful "heuristics"? How does the work of Kraepelin exemplify the minimal interpretation of the medical model? What is meant by a "syndrome-based conception" of mental illness, and how does this relate to Kraepelin's view? What is the key difference in focus between the minimal interpretation and the strong interpretation of the medical model? How does the DSM (Diagnostic and Statistical Manual of Mental Disorders) reflect the minimal interpretation of the medical model? What is the significance of its focus on syndromes rather than causes? What are some of the criticisms leveled against the DSM's approach to classifying mental disorders? Why do some theorists see the neglect of causal structure as a barrier to scientific progress in psychopathology? What is the difference between reliability and validity in the context of psychiatric diagnoses, and why does this distinction matter when considering different interpretations of the medical model?  S2: The "mental" in mental health (Sept 13) Why is the DSM's approach to bereavement controversial, and what does this controversy reveal about the underlying assumptions of the minimal and strong interpretations of the medical model? According to the source, what does the DSM say about the cause of mental disorders? How does this align or not align with the minimal and strong interpretations of the medical model? What is the metaphysical challenge to the strong interpretation of the medical model? What is the difference between latent variables and unobservables, and how does that relate to psychiatric disorders? What is the normative challenge to the strong interpretation of the medical model? How does the strong interpretation of the medical model differ from the minimal interpretation in its understanding of mental illness? What is the role of "pathogenic processes" in the strong interpretation? According to the source material, what is the significance of "normal function" in the context of the strong interpretation of the medical model? How does one identify when there is a departure from normal function? What is meant by a "multi-level science" in the context of psychiatry, and how does this relate to different approaches to explaining mental illness? Does the strong model require explanations at one level (e.g. the molecular level)? What does it mean to say that a pathogenic process does not have to be "destructive" to be relevant? What role does cognitive neuroscience play in the strong interpretation of the medical model? Is molecular biology also a relevant theory in the strong interpretation? What is the manipulationist account of causation, and why might it be relevant to psychiatric explanations? How does the concept of a "background theory" relate to the strong interpretation of the medical model? What are some options for a background theory, and are they compatible with each other? What are some of the challenges or considerations for the strong interpretation that the source material raises, such as environmental factors and reductionism? What is "genetic reductionism"? Havi Carel (2016) "Why Use Phenomenology to Study Illness?" Summary Somatic illnesses Carel’s own experiences with lymphangioleiomyomatosis (LAM) 2.1 Minimal interpretation of the medical model Mental disorders are collections of co-occurring symptoms that unfold predictably, w/o specifying underlying causes  S2: The "mental" in mental health (Sept 13) Observable phenomena; diagnostic labels are useful heuristics, not natural kinds Draws on kraepelin’s work and the DSM’s syndrome-based approach Proponents of the view: Guze, McHugh and Slavney Core idea: minimal interpretation of medical model views mental disorders as collections of symptoms that occur together and unfold in characteristic ways 2.2 The DSM Conception and its Critics DSM treats mental disorders as syndromes consistent with the minimal model Criticized for neglecting causal structure, relying on surface features that can mask underlying differences A valid diagnosis should be grounded in bioloigical processs identified by scientific methods Challenges idea that science can reveal how the world is “really put together” and that diagnoses can be validated as “real” disorders Examples of criticisms: pathological gambling, depression, and introduction of the Research Domain Criteria (RDoC) 2.3 Strong Interpretation of the Medical Model Mental illness is a pathogenic process in bodily systems, requiring specific causal hypotheses about neurobiological mechanisms Seeks explanations that cite pathogenic processes in brain systems and assumes a background theory of normal function Doesn’t necessarily require reductive explanations, and recognizes mental illnesses have multiple causes Adopts a manipulationist view of causation: causes are identified based on what can be controlled, instead of molecular reductionism Focuses on explaining symptoms based on disruptions to normal biological and cognitive processes and clinical usefulness of such explanations Key Points/Concepts Q. What are the applications of Carel’s claims to mental health disorders? 2.1 Minimal Interpretation of the Medical Model: ○ Identifying and classifying disorders based on observable symptoms ○ Diagnostic labels should be a starting point for investigation, not a definitive category ○ Observable symptoms > generalized theories 2.2 The DSM Conception of Mental Illness and its Critics ○ Standardized set of criteria ○ Predictive validity of a condition and response to treatment ○ Understand the underlying causes of mental disorders  S3: The "disorder" in mental disorders (Sept 20) LECTURE NOTES Summary Sociopolitical accounts of mental health and mental disorders Different characterizations of “disorder” What do different accounts of disorder mean for how we approach bioethics today? Learning Objectives (1) survey some common approaches to determining what "disorders" are (2) interrogate some of the assumptions of those approaches against ongoing histories of oppressive violence and abuse of diagnostic practices (3) reflect on non-psychiatric accounts of mental difference and neurodivergence (4) interrogate what we think should count as a mental disorder, and what we want labels like these to do in the world. The next two sessions will then turn to focus on specific issues in diagnostic ethics. Key Points/Concepts Normalcy and Disorder Health: normal functioning; normality as both statistical and biological Competing conceptualizations of “normal” Are deviations from a norm negative or disordered Thick moral concept: something like the concept of “normal” Mental disorder terminology Mental disorder Mental illness Psychiatric condition Neurotypical Neurodivergent Case Studies: Race and Disorder 1. Drapetomania: In the 1800s, this was considered a "disease of the mind" that caused enslaved Black people to flee captivity. Treatment involved kindness and punishment to enforce submission 2. Schizophrenia: In the 1900s, the diagnosis of paranoid schizophrenia was used to incarcerate Black protestors, with symptoms described in terms of hostility to white values. "Sluggish schizophrenia" was also used 3. Excited Delirium: In the 2000s, this condition, primarily invoked as the cause of death of Black people in police custody, has been described as a way of excusing excessive force by officers Medicalization and the Social Context How medicalization pathologizes normal human distress, especially in relation to trauma Quote: Summerfield (1999) - medicalization of distress leads to a “missed  S3: The "disorder" in mental disorders (Sept 20) identification between the individual and social world, and a tendency to transform the social into the biological” How Western conceptions could harm non-Western communities through globalization Indigenous language and community: highlights importance of cultural frameworks for health and wellness + colonial implications ○ Quote: “When bay is a noun, it is defined by humans, trapped between its shores and contained by the word. But the verb wiikwegama [in Anishinabemowin]—to be a bay—releases the water from bondage and lets it live.” Looping Effects Ian Hacking: “looping effects” Diagnostic label influences self-understandings, interpretations, behaviours and experiences of patients Alters original meaning of a symptom or diagnosis Ex. how algorithms on social media (e.g. Tiktok) create groups of people who interact with specific content, subsequently altering the meaning of that content Object permanence: how clinical language can be misunderstood → changes to existing clinical language Community Approaches Advocates for a rights-based approach to mental illness ○ Emphasis on disability rights, policy changes, and social inclusion Critiques of “ableism,” “sanism,” and “mentalism” ← these systems of oppression must be understood and combatted for real justice to occur Shift from individualistic, biomedical perspectives → social, structural, and collective understanding of mental health and illness Case Study: Prolonged Grief Disorder The validity of PGD as a “real” mental disorder Cultural differences in mourning practices (e.g. Ruism, Zhuangzi, Daoism) ← need for cultural sensitivity in diagnostic criteria Case Study: Recurrent Restrictive Sleep Disorder (RRSD) Made-up condition Q. How do we determine what is a “real” condition The subjective nature of diagnoses Q. What makes a real disorder vs a made-up one? What do we do if a large population meets the criteria for a questionable diagnosis Important quotes and Shifting concept of normality  S3: The "disorder" in mental disorders (Sept 20) References Quote: "Christopher Boorse (1977): Health is “normal functioning, where the normality is statistical and the functions biological.”" Medicalization and its Dangers Quote: Summerfield (1999) states that medicalization of distress leads to a “missed identification between the individual and the social world, and a tendency to transform the social into the biological.” Indigenous conception and language differences: ○ Quote: “When bay is a noun, it is defined by humans, trapped between its shores and contained by the word. But the verb wiikwegama [in Anishinabemowin]—to be a bay—releases the water from bondage and lets it live.” Looping effects and influence on diagnosis: Quote: "The diagnostic label is premised upon a set of symptoms, but its fuller meaning is captured and then changed by peoples’ own relationships to that label and society’s interactions too." Implications & 1. How do we balance the biomedical understanding of mental health with Questions Raised social, cultural, and environmental factors? 2. Who has the power to define "normal" and to pathologize certain behaviors? 3. How can we prevent diagnoses from being used to reinforce social inequalities and biases? 4. How do looping effects impact the experience of mental illness and how can we better understand and address them? 5. What role should community and justice-oriented approaches play in mental health care? 6. What are the ethical considerations around the use of diagnostic criteria, particularly in cross-cultural contexts? Key Terms/Definitions Biomedical psychiatry: approach to mental disorders that focusses on identifying biological and neurological causes ○ I.e. brain structures and functions Phenomenology: study of structures of experience and consciousness ○ Understanding mental disorders through lived experience rather than just symptoms and biological factors ○ The embodied experience Thick moral concept: combines descriptive and normative, evaluative content ○ “Normal” is not neutral, but contains value judgments Drapetomania: (now-discredited, supposed mental illness) pathologizes act of enslaved Black people trying to escape captivity ○ Importance: demonstrates how disorder can be socially constructed to justify oppression  S3: The "disorder" in mental disorders (Sept 20) Used to justify subjugation of enslaved people Excited Delirium: controversial diagnosis invoked as cause of death in police custody, particularly of Black individuals Medicalization: process by which non-medical problems become defined and treated as medical problems ○ May involve medical interventions ○ Concerns about pathologizing normal human distress and globalizing Western medical concepts The Grammar of Animacy: diff languages structure our understanding of the world in diff ways ○ Ex. some indigenous languages verb conjugations indicate a more active and less object-oriented relationship with the world Looping effects: how diagnostic labels and classifications interact with and change people’s self-understanding and societal perceptions ○ Feedback loop that alters meaning over time ○ Ex. how social media creates looping algorithms Rights-based approach: advocating for legislation and policy changes to ensure rights and inclusion Justice-oriented approach: address root causes of inequality and oppression Ableism: discrimination and social prejudice based on belief that typical abilities are superior Sanism: discrimination and social prejudice based on belief that normal mental state is superior to abnormal one Normal functioning: normality (in terms of health) is statistical and the functions biological Mental disorder: multiple dimensions → an experience, a brain disease, a syndrome, a value judgment, response to environments Recurrent Restrictive Sleep Disorder (RRSD): made-up condition used to question how we determine what a real condition is ○ Based on empirical data in students Questions for Review How do Haslanger and Peirce's approaches to understanding mental disorders differ from a purely biomedical one? What does it mean to consider "normal" as a "thick moral concept," and how does this relate to defining mental disorder? Briefly describe how the concept of "drapetomania" was used in the 1800s, and what does it illustrate about the social construction of disorder? What is "excited delirium," and why is it a controversial diagnosis? How does Summerfield challenge a purely biomedical approach to understanding trauma and distress? What is the significance of the phrase "the grammar of animacy" in relation to Indigenous ways of understanding health and well-being? What are Ian Hacking's "looping effects" and how do they relate to diagnostic  S3: The "disorder" in mental disorders (Sept 20) labels? How does Chevalier's example of TikTok algorithms illustrate the concept of looping effects? What is the difference between rights-based strategies and justice-oriented strategies in the context of disability and mental health? Why might the presented case of Recurrent Restrictive Sleep Disorder (RRSD) be useful for understanding the nature of mental disorders? Derek Summerfield (1999) "A Critique of Seven Assumptions Behind Psychological Trauma Programmes in War-Affected Areas" Summary Critique of Western-style psychological trauma programs in Bosnia and Rwanda Argument: programs funded by large intl organizations based on flawed understanding of trauma and a Western-centric view of distress PTSD is misapplied → medicalizing normal suffering and ignoring social, cultural, and economic contexts of war survivors Programs undermine local coping mechanisms and priorities Proposed solution: humanitarian efforts should prioritize addressing social and material devastation of war instead of imposing Western psychological models Context for why topic is important Key Points/Concepts Medicalization of Distress Western culture frames distress through medical and psychological lens → displacing religious and social explanations Leads to labeling of normal responses to war as a pathology (trauma) The social construction of PTSD PTSD officially recognized in 1980 → rooted in experiences of US Vietnam War veterans PTSD diagnosis conferred benefits like victimhood, moral exculpation, and disability pensions Critique of Seven Assumptions Behind Trauma Programs Challenges traumatization as it pathologizes normal suffering Western models ignores cultural and situational context ○ Ex. case study in Rwanda where children demonstrated resilience and adaptability despite traumatic events Most distress is normal, even adaptive → may not even require psychological intervention Emotional processing is product of western culture Targeting vulnerable groups and individuals risks reinforcing a victim identity and ignoring other aspects of their experience  S3: The "disorder" in mental disorders (Sept 20) Idea that unresolved trauma leads to violence is unfounded Lack of evidence to support efficacy of Western psychological approaches Power and Colonialism Imposing Western psychological frameworks is a form of cultural imperialism Can disempower war survivors by labelling them as sick The Importance of the Social World The social world (sense of community, sharing meaning and values) is most important factor in resilience — much more so than any treatment Advocating for supporting social institutions, local knowledge, and traditional coping mechanisms Need for Indigenous Knowledge and Context Must recognize indigenous definitions of health and mental health Key Terms/Definitions Medicalization: The process by which human conditions or problems become defined and treated as medical issues, often leading to the adoption of medical terminology and practices to address them. Posttraumatic Stress Disorder (PTSD): A mental health condition that can develop after a person has experienced or witnessed a traumatic event, characterized by symptoms such as flashbacks, nightmares, and severe anxiety. Trauma Discourse: The collection of ideas, language, and practices that shape how trauma is understood and addressed within a particular cultural or social context. Pseudocondition: A term used in the article to describe the way in which the understandable suffering of war is misconstrued as a technical psychological problem (trauma) when it is often the result of a social world targeted by war. Social World: The network of social relationships, cultural norms, and community structures that shape people's experiences and identities. Ethnomedical Systems: Traditional or indigenous medical systems and practices rooted in specific cultural contexts, that may include supernatural, spiritual, and moral realms, not just physical or mental ones. Category Fallacy: A mistake in logic that occurs when it's assumed that because phenomena can be regularly identified across different social contexts, they mean the same thing in those settings. Emic Perspective: An approach to studying culture that focuses on understanding beliefs and practices from the viewpoint of the people within that culture. Etic Perspective: An approach to studying culture that focuses on creating objective and generalizable frameworks that can be applied to different cultures, and can be compared across groups. Medicalized trauma discourse: An approach that is based on Western science  S3: The "disorder" in mental disorders (Sept 20) and medicine. It defines trauma as a disease caused by traumatic events, requiring treatment by medical experts. This discourse can neglect the social, cultural, and political dimensions of war-related suffering. Questions for Review According to Summerfield, what is the primary issue with psychological trauma programs in war zones? How did the diagnosis of PTSD become prominent in Western culture, and what group was it initially associated with? What does the article suggest about the relationship between traumatic events and traumatic memories? Why does the author find the use of PTSD checklists problematic in war-affected areas? What is "active forgetting," and how does it contrast with Western approaches to trauma? What are some examples of "vulnerable groups" that are often targeted in trauma programs? According to the author, what is the fundamental problem with viewing war as a mental health emergency? How does the article critique the assumption that emotional ventilation and "working through" experiences are universally helpful? How does the author explain the potential negative impact of Western-led trauma programs on local communities? What does the author suggest about the role of social context in understanding and addressing the effects of war? Alicia Elliot (2016) "A Mind Spread Out on the Ground." Summary Complexities of depression, interweaving personal experience with historical and cultural perspectives How societal forces (colonialism) shape mental health for Indigenous people Elliot critiques limits of Western medical models and seeks to understand own culture and language Key Points/Concepts Inadequacy of Western diagnostic frameworks for Indigenous experiences of depression Elliot’s own experience: difficulty articulating depression with therapist ○ Therapist’s focus: identifying cause ○ Elliot’s challenge: unable to neatly categorize experience within conventional categories Elliot’s mother received multiple mental health diagnoses → limitations and harmful nature of medical labels ○ “-turning every feeling she had into yet another symptom of yet another disease” S3: The "disorder" in mental disorders (Sept 20) Standard mental health resources fail to acknowledge impact of “intergenerational trauma, racism, sexism, colonialism, homophobia transphobia” on mental health Critique: lack of culturally appropriate care and reduction of human experience to symptoms Historical and cultural context of mental illness — esp. “Demonic possession”: “Melancholia” once considered demonic possession → use of “cures” like exorcism, beatings, and execution Link btw historical demonization of mental illness and demonization of Indigenous peoples Case study: Salem witch trials ○ Indigenous ppl accused of witchcraft and Devil described as being “Indian colour” Discovery Doctrine: used to justify colonization; based on idea Indigenous people not christian → so “devil worshippers” Intergenerational trauma of colonialism as a major factor in Indigenous mental health Colonial violence in residential schools created deep trauma and pain → poor mental health outcomes Quote: “Suicide and depression rates for our people are twice the national average. For Native youth ages from fifteen to twenty-four, the suicide rate is five to seven times the national average.” Epidemics, forced assimilation, and land dispossession linked to depression and numbness The importance of culture and language in healing and understanding Cultural continuity, incl. Self-government, land control, education, and command of community services linked to lower rates of depression and suicide Meaning of depression in Mohawk → nuanced understanding of mental distress differs from the West Loss of language and culture through intentional suppression by colonial powers impacted mental health Metaphor of colonialism as depression Parallels between symptoms of colonialism and symptoms of depression: shared destructive nature ○ “To light us on fire and let us burn” How the checklist of symptoms for depression reflects the effects of colonization  S3: The "disorder" in mental disorders (Sept 20) Hope for healing and reclaiming culture Hope to create a sort of condolence ceremony for melancholic depression The power of language, culture and community in reclamation Key Terms/Definitions Melancholia: An old term for depression, often associated with a sense of profound sadness and pensiveness. Historically, it was sometimes considered a form of demonic possession. Endogenous Depression: A type of depression that arises without any clear external cause, as opposed to reactive depression. It is sometimes referred to as melancholic depression. Exogenous Depression: Also called reactive depression, this type of depression is triggered by identifiable external events such as divorce, job loss, or the death of a loved one. Onkwehon:we: An Indigenous term, meaning “original people.” This is a term used by the Haudenosaunee people to refer to themselves. Haudenosaunee: A confederacy of six First Nations, including the Mohawk, Oneida, Onondaga, Cayuga, Seneca, and Tuscarora peoples. The author is Haudenosaunee. Doctrine of Discovery: A legal concept that gave Christian European nations the right to claim and colonize lands inhabited by non-Christians. Intergenerational Trauma: The transmission of trauma and its effects across generations, as experienced by Indigenous people who have suffered the impacts of colonization. Cultural Continuity: The preservation and active practice of traditional cultural elements, including language, customs, and governance; it is associated with better mental health outcomes for Indigenous peoples. Wake’nikonhra’kwenhtará:’on: A Mohawk phrase, translated roughly to "his mind is stretched out on the ground," used to describe a state of depression. Wake’nikonhrèn:ton: A Mohawk phrase, translated roughly to "the mind is suspended," also used to describe a state of depression. LGBT2S: An acronym standing for Lesbian, Gay, Bisexual, Transgender, Two-Spirit, and other sexual and gender minorities. Wampum: A traditional shell bead used for trade, gifts, and record-keeping by Indigenous peoples in Eastern North America. It can be used to signify agreements and create understanding between different groups. Questions for Review 1. Why did the therapist’s reaction remind the author of residential schools? 2. How did the author's family structure in the trailer impact her mother's mental health? 3. Describe how the author's mother's depression manifested physically. 4. What are the historical connections made between mental illness and demonic possession? 5. How was the demonizing of Indigenous people connected to colonization?  S3: The "disorder" in mental disorders (Sept 20) 6. What does the author say about the "Discovery Doctrine"? 7. What specific cultural factors does the author connect to higher rates of suicide and depression in Indigenous communities? 8. Describe the Mohawk phrases used to describe depression and how they differ from Western terms like "melancholia" or "endogenous depression." 9. How does the author use the metaphor of colonialism to describe the effects of depression? 10. What is the significance of the Haudenosaunee condolence ceremony to the author? Owen Chevalier (2024) "'It Starts on TikTok': Looping Effects and the Impact of Social Media on Psychiatric Terms" Summary How Tiktok’s algorithm influences public understanding of psychiatric terms Redefiniton of “object permanence” as a ADHD symptom Primary argument: object permanence exemplifies a looping effect, where online communities reshape terminology through interaction with social media → impacts on public perception and potential for diagnostic revisions Context for why topic is Raises questions about the validity of online-driven concept shifts and their important potential influence on professional psychiatry Considers whether this phenomenon represents a genuine expansion of understanding or a form of misinformation spread through a feedback loop Key Points/Concepts Rise of Mental Health Discourse on Social Media Explosion of mental health conversations online on Tiktok ○ Ex. hashtag “#adhd” ○ Effects: increase in adults seeking ADHD diagnoses → pandemic exacerbated symptoms A double-edged sword: online info increases public understanding BUT leads to misunderstandings of research The Case of Object Permanence (OP) and ADHD Original definition of OP: term from developmental psychology; refers to an infant’s understanding that objects continue to exist even when out of sight Tiktok’s reinterpretation of OP: repurposed OP as a symptom of ADHD; describing forgetfulness and inattention ○ Shift not based on experts, but gained viral popularity through Tiktok’s algorithm Hacking’s Looping Effect Ian Hacking Hacking argues mental health terms are both “indifferent kinds” (underlying S3: The "disorder" in mental disorders (Sept 20) biological pathology) and “interactive kinds” (socially constructed and shaped by the label and those who bear it) Looping effect: how classifications of people change in response to being classified Traditionally, psychiatric experts and institutions act as gatekeepers for definition of disorder ○ Tiktok’s emergence as a substitute: algorithms categorize and label users Tiktok’s Algorithm as an Engine for Change Algorithm categorizes users based on engagement → creates labels → influences experience Algorithm acts as feedback loop Algorithmic looping: alter way psychiatric terms are understood Revised looping mode; Traditional model:nperson who is not an expert creates term → disperses on platform → individuals within loop are labelled → creation of feedback loop Improved model: directly involving experts/psychiatrists in the looping effect Concept Creep and the Expansion of Terms Concept creep: how meaning of OP expanded vertically (to include milder versions of the original concept) and horizontally (to include a new symptomatic meaning) Role of Tiktok Creators Community loop: tiktok creators using other creators for cues about important topics and which ones will become viral Content creators began revising beliefs → highlights dynamic nature of online spaces KEY TAKEAWAYS - TikTok is a powerful force shaping the public’s understanding of mental health terms. - The platform's algorithm acts as a new, faster engine for "looping effects," altering the meaning of psychiatric concepts. - The case of "object permanence" highlights the potential for both positive and negative impacts of community involvement on scientific discourse. - Psychiatrists need to engage with online mental health communities to understand and address the unique challenges and opportunities that they present. - It is critical to understand how algorithms, and the economic drivers behind them, shape the flow of information, and how this may distort and co-opt the  S3: The "disorder" in mental disorders (Sept 20) public conversation. - There needs to be further research on the impact of algorithms and looping effects in the context of online mental health spaces. Key Terms/Definitions Looping Effect: A cycle where a term or concept is introduced, adopted, and reinterpreted by individuals or groups, which can then loop back to affect the original meaning, or how the term is understood by individuals. Indifferent Kinds: In Hacking's framework, the existing, underlying, and biological or pathological reality of a condition, which exists independently of human understanding. Interactive Kinds: In Hacking's framework, the socially constructed categories and labels assigned to conditions that interact with and are changed by the people classified within them, and society more generally. Object Permanence (Traditional): A concept in developmental psychology that describes the understanding that objects continue to exist even when they are not visible. This is a stage of development during infancy. Object Permanence (TikTok Definition): A reinterpreted definition of "object permanence," used on TikTok to describe ADHD symptoms related to forgetfulness and inattention that occur when things are out of sight. Social Construction: The idea that concepts are shaped by cultural and social contexts. The meanings of words and concepts aren't fixed, but rather are constructed by people's beliefs, behaviours, and interactions. Concept Creep: A phenomenon where concepts, especially in psychology, expand to include milder or related conditions, leading to both vertical and horizontal expansion. Vertical Expansion: A kind of concept creep where a term is understood to include milder variants of the original concept. Horizontal Expansion: A kind of concept creep where a term is understood to include entirely new phenomena not originally covered by the concept. Digital Ethnography: A research methodology that seeks to understand online communities and communication, as well as study how technology impacts social relations and behaviours. ADHD: Attention-deficit/hyperactivity disorder; a neurodevelopmental condition characterized by inattention, hyperactivity, and impulsivity. DSM (Diagnostic and Statistical Manual of Mental Disorders): A comprehensive guide for the classification and diagnosis of mental disorders. It is produced by the American Psychiatric Association. Questions for Review 1. According to Chevalier, what is the "looping effect" in the context of social media and psychiatric terms? 2. Explain Hacking’s concepts of "indifferent kinds" and "interactive kinds" in relation to mental health terms. 3. How has the term "object permanence" been revised on TikTok, according to  S3: The "disorder" in mental disorders (Sept 20) the article? 4. How do social media algorithms, specifically on TikTok, contribute to the looping effect? 5. What role do TikTok creators play in the revision and dissemination of psychiatric terms? 6. How does Chevalier’s account of the TikTok loop differ from Hacking's original framework, and why? 7. What is "concept creep" as discussed in relation to the term "object permanence" and ADHD? 8. What research method does the author use to gather information about how creators understand and use mental health terms? 9. What motivations do some ADHD influencers have for presenting information about mental health conditions on TikTok? 10. What are the potential positive and negative impacts of social media influence on psychiatric discourse, according to the author? S4: Enduring issues in diagnostic ethics (Sept 27) LECTURE NOTES Summary Discussion of the “Goldwater Rule” Discussion of self-diagnosis Learning Objectives (1) explore some common issues in the ethics of diagnosis (2) interpret and interrogate those issues against the previous three sessions' content (3) reflect on what the value of diagnosis is, or what conditions it (4) develop some further initial practice on conducting research. Key Enduring Issues in Diagnostic Ethics Points/Concepts Value-Laden Diagnoses: diagnostic categories aren’t neutral, but “deeply value laden” ○ Naming and categorizing carries social meanings and stigma ○ Not based on objective medical facts Social impact of diagnosis: concerns about stigma; impacts on employment, insurance, risks of incarceration Phenomenology vs. Diagnostic Instruments: limitations of diagnostic tools in fully capturing phenomenological (lived) experience Upfront barriers to diagnosis: ○ Stigma ○ Misinformation ○ Geographic barriers ○ Financial limitations  S4: Enduring issues in diagnostic ethics (Sept 27) ○ Pre-existing negative experiences ○ Language Interpretation and “Diagnostic Listenining” ○ Diagnostic listening: interpretation of observable characteristics ○ Concerns of this practice: bias from patient and clinician Egosyntonicity: sense of “integration or belonging with one’s apparent condition” ○ Experiences of “disorder” as part of identity → conflicts within diagnostic frameworks ○ Ex. desired mania in Bipolar Disorder Duration: tension between “strong” and “minimal” biomedical models for diagnostics — esp. For symptom management, potential for misdiagnosis and “looping effects” ○ Cultural Considerations: CFI is a tool to assess cultural factors relevant to care ○ Cultural concepts of distress: idioms, explanations, and syndromes ○ Examples: Kufungisisa (thinking too much): used amongst the Shona people Hikikomori (social withdrawal): used in Japan Gov considers hikikomori a symptom of various diseases and not a single disorder ○ Goal of CFI: Address concerns about pathology Avoid misdiagnosis Collect clinically relevant information Foster patient engagement Improve therapeutic efficacy Support clinical research Stigma and language ○ Ex. transition from Sheishin Bunretsu Byo (split mind disease) to Togo Shitcho Sho (integration disorder) to combat stigma around schizophrenia Limitations of Cultural Competency Training: ○ 1 hour training time ○ Can be redundant ○ Atek up too much time ○ Reliant on patient testimony The Uses of Diagnosis Binarism and simplification: binarist thought oversimplifies complexities of lived experience Abuse justification: diagnosis historically used to justify abuse and oppression ○ E.g. Drapetomia, labelling ppl in Fairview and Rotenberg institutions Pathologization of Variance What should be considered a disorder and what is the reason for diagnosing it? How is the diagnosis of gender dysophoria used as a precondition for gender affirming  S4: Enduring issues in diagnostic ethics (Sept 27) therapies? When is demedicalization based in ableism and disavowal of disability? The “Goldwater Rule” Prohibits mental health professionals from commenting publicly on mental health of individuals they have not personally examined Key Takeaways: Diagnostic categories and practices are complex and not simply objective medical judgments. They are deeply embedded in social, cultural, and political contexts. The lecture encourages critical reflection on the power dynamics inherent in the diagnostic process, including who gets diagnosed, how, and with what consequences. The material stresses the importance of a culturally sensitive and nuanced approach to diagnosis, recognizing that expressions of distress are culturally variable. The lecture also stresses the importance of acknowledging the limitations of "objective" diagnostic approaches, stressing the importance of interpretation, listening and acknowledging different perspectives. Key Cultural Formulation Interview (CFI): A semi-structured interview designed to assess Terms/Definitions cultural factors relevant to an individual’s mental health care, focusing on their personal experience and social contexts. Cultural Concepts of Distress: Broad categories encompassing cultural idioms, explanations, and syndromes, shaping how individuals understand and experience distress. Cultural Idioms of Distress: Ways of expressing distress that are specific to a cultural group, such as "burnout" or "nerves." Cultural Explanations: Perceived causes for symptoms or distress within a cultural context, like overwork, spirits, or colonialism. Cultural Syndromes: Clusters of symptoms that co-occur within specific cultural groups, such as "Kufungisisa," or a form of depression associated with overthinking, in the Shona community of Zimbabwe and Mozambique. Diagnostic Listening: An approach that involves actively listening to and interpreting patient testimonies for diagnostic purposes, keeping in mind the presence of bias and cultural differences. Egosyntonicity: The experience of harmony or integration with one’s condition; disorder feels as if it is part of “who I am” as opposed to a separate entity. Hikikomori: A condition characterized by extreme social withdrawal, primarily in Japan. It is regarded by the Japanese Ministry of Health, Labor, and Welfare as a symptom of other issues rather than a single disorder. Kufungisisa: A Shona term meaning "thinking too much," considered a common idiom of distress and explanation of distress, related to rumination and depression. Medicalization/Pathologization: The process by which human conditions or behaviours are defined and treated as medical problems or disorders.  S4: Enduring issues in diagnostic ethics (Sept 27) Principleism: A method of ethical reasoning based on a set of principles often, though not exclusively, applicable to bioethics, including respect for autonomy, non-maleficence, beneficence, and justice. Stigma: Negative social attitudes and beliefs attached to a particular condition or group, often resulting in discrimination and social exclusion. White Coat Effect: A phenomenon where a patient's behaviour or symptoms change when they are in a clinical setting or in the presence of healthcare professionals. “Goldwater Rule”: An ethical rule that prohibits mental health professionals from commenting publicly on the mental health of individuals they have not personally examined. Questions for 1. Explain the concept of "egosyntonicity" in the context of mental health diagnoses. Review 2. What is the "white coat effect," and how can it impact the diagnostic process? 3. According to the lecture, what are three potential barriers to accessing mental health care? 4. Briefly describe the purpose of the Cultural Formulation Interview (CFI) as presented in the lecture. 5. Define "cultural idioms of distress," and provide an example mentioned in the lecture. 6. What is "kufungisisa," and in what cultural context does it originate? 7. Explain why Hikikomori is not considered a single disorder by the Japanese Ministry of Health, Labor, and Welfare. 8. What are some of the positive and negative implications of labeling, as discussed in relation to the works of Clare? 9. How does Ashley’s discussion of gender dysphoria challenge the typical medical model of diagnosis? 10. What is the "Goldwater Rule" and what ethical considerations does it raise regarding mental health professionals? Eli Clare (2017) "In tandem with cure" (pp. 37-49) Summary Author’s experience with cerebral palsy and complex implications of medical diagnosis ○ Childhood diagnoses at institutions with eugnenicist histories → adult interactions with healthcare providers Clare’s critique of power dynamics inherent in diagnosis: sued as a tool for access to care and a mechanism for oppression and institutionalization How do diagnoses shape individual lives and societal perceptions of disability? Key Personal Narratives as a lens: Points/Concepts Dehumanizing aspects of medical assessments: own experiences at the "Crippled Children's Division" (CCD) ← objectifying experience during diagnostic process The quest for a “cure” Importance of adaptation over treatment ○ Ex. author finding success in using an electric typewriter over medical  S4: Enduring issues in diagnostic ethics (Sept 27) interventions The power of diagnosis The double-edged sword of diagnosis ○ How it "transforms our three- dimensional body- minds into two- dimensional graphs and charts, images on light boards, symptoms in databases, words on paper." Diagnosis is a process, not a stiatic truth Case study: “mental retardation” → influences life outcomes and quality of life Historical context of disability and eugenics History of institutions like the Oregon Fairview Home (original name: “State Institution for the Feeble-Minded”) Historical link between diagnosis and eugenics Shifting and problematic language of diagnosis: historically using terms like idiot, imbecile, retarded, etc. How IQ tests justified discrimination against immigrants Eugenics legislation in Oregon that sterilized individuals with developmental disabilities “Disorder” as a social construct Diagnosis projects concept and practice of disorder within Western medicine Disorder seen as wrong, broken, in need of repair Alternative understandings and experiences Different frameworks in experience with bronchitis: ○ Western doctor: bronchitis Focus on bacteria, symptoms, acute intervention ○ Acupuncturist - Eastern medicine: “heat in my lungs” Focus on elements, energies, balance Efficacy > correctedness The high price of diagnosis Must question diagnosis for whom and what ends The contradictory nature of diagnosis ○ Must recognize harms and benefits Key Cerebral Palsy: A group of disorders affecting movement and muscle tone or posture, Terms/Definitions caused by damage that occurs to the immature, developing brain. Crippled Children's Division (CCD): A division at the University of Oregon where the author received diagnostic testing as a child. Eugenics: A set of beliefs and practices that aim to improve the genetic quality of a human population, often through discriminatory and coercive means.  S4: Enduring issues in diagnostic ethics (Sept 27) Henry Goddard: An American eugenicist who translated and popularized intelligence tests, using them to classify and label people with intellectual differences. Fairview Hospital and Training Center (Oregon Fairview Home): A state institution for individuals with developmental disabilities, historically known for poor conditions, eugenic practices, and mistreatment. Mental Retardation: An outdated and offensive term used to describe individuals with intellectual disabilities, which carries significant stigma. Diagnostic and Statistical Manual of Mental Disorders (DSM): A widely used handbook by medical and mental health professionals for diagnosing psychiatric disorders. International Classification of Diseases (ICD): A global system for classifying diseases and health problems, used for health management and data purposes. Disorder: In the context of medical diagnosis, a term used to denote a condition that is not considered typical or "normal," implying something is broken and in need of repair. Medical-Industrial Complex: A term used to describe the interconnected network of health care providers, insurance companies, pharmaceutical companies, and other related industries. Stelazine and Thorazine: Anti-psychotic medications, often used in institutions like Fairview to manage patient behavior. Judge Rotenberg Educational Center: A residential institution that uses electric shock as a form of behavior modification for individuals with disabilities. Questions for 1. What childhood experience led to the author's cerebral palsy diagnosis, and what Review was their parents' initial reaction to the diagnosis? 2. Describe the author's experience with orthopedic equipment, particularly the cuffs and magnets, and how did this impact them? 3. What was the significance of the Oregon Fairview Home (formerly the State Institution for the Feeble-Minded), in the context of the author's experiences and historical context? 4. How was eugenics, particularly the work of Henry Goddard, connected to the author’s experience of being tested at the Fairview facility? 5. Explain the concept of “disorder” as it relates to medical diagnosis, and what implications it has for individuals with disabilities or differences? 6. Contrast the author’s experiences and understanding of the bronchitis diagnosis from Western medicine, and the “heat in the lungs” diagnosis from traditional Chinese medicine. 7. In what ways did the diagnosis of “mental retardation” impact people who were sent to institutions like Fairview, specifically referencing the story of Molly Daly? 8. How does the author use the examples of daily life and treatment at Fairview to demonstrate the violence set in motion by diagnosis? 9. What is the Judge Rotenberg Educational Center, and what does its practices illustrate about the potential abuse enabled by diagnosis?  S4: Enduring issues in diagnostic ethics (Sept 27) 10. What key question does the author pose regarding the usefulness of diagnosis, and what are the conflicting uses they provide? Mitsumoto Sato (2006) "Renaming schizophrenia: a Japanese perspective." Summary Japan’s 2002 renaming of schizophrenia from the stigmatizing "Seishin Bunretsu Byo" ("mind-split-disease") to the less stigmatizing "Togo Shitcho Sho" ("integration disorder") Goal: improve patient care and reduce negative societal perceptions Impact: positive impact of name change → increased patient diagnosis disclosure → shift toward vulnerability-stress model of treatment Key Stigma Reduction as the Primary Driver Points/Concepts Old term contributed to negative public image of schizophrenia: untreatable, deteriorating Families of individuals with schizophrenia, through the National Federation of Families with Mentally Ill in Japan (NFFMIJ), spearheaded the push for renaming, emphasizing the need to remove the harmful impact of the diagnosis​​ Shift in Understanding of Schizophrenia Renaming moved away from the Kraepelinian disease concept: viewing schizophrenia as a progressive, degenerative illness similar to dementia New term: "Togo Shitcho Sho" ("integration disorder") ○ Better aligned with vulnerability-stress model of schizophrenia ○ Posits disorder arises from biological vulnerabilities and environmental stressors ○ Emphasis on possibility for treatment, recovery, and social integration Improved Communication and Patient Care BEFORE: psychiatrists reluctant to inform patients of schizophrenia diagnosis due to stigma AFTER: increase in patients being informed of diagnosis + improved treatment compliance Process of Renaming "Togo Shitcho Sho" ("integration disorder") selected because it didn’t disadvantage patients → conveyed schizophrenia is a syndrome and not a disease Implementation and Impact Used in 78% of cases after 7 months New policy implementations Improved treatment guidelines for schizophrenia: ○ Community-based care over hospital-centered care  S4: Enduring issues in diagnostic ethics (Sept 27) ○ Multi-axial assessments based on DSM-IV-TR ○ Treatment planning for different phases of the illness Historical Context of Mistreatment First half of 20th century: law required families to take custody of individuals with disorder → mistreatment, confinement, restraints Important quotes "The renaming was triggered by the request of a patients' families group." and References "The first reason for the renaming was the need to remove the harmful impact of the diagnosis with the old term on the patients and their families." "The old term identified the patient as a person with a disorganized personality even after recovery or full remission." "The new term for schizophrenia ("Togo Shitcho Sho") refers to the vulnerability-stress model, and implies that the disorder may be treated and that recovery is possible..." "The renaming increased the percentage of cases in which patients were informed of the diagnosis from 36.7% to 69.7% in three years." Key Seishin Bunretsu Byo: The old Japanese term for schizophrenia, literally translating to Terms/Definitions “mind-split-disease.” Togo Shitcho Sho: The new Japanese term for schizophrenia, literally translating to “integration disorder.” JSPN: Japanese Society of Psychiatry and Neurology, the organization that spearheaded the renaming initiative. Kraepelinian Disease Concept: A historical view of schizophrenia as a disease with a predictable course of deterioration, which had been a long-standing viewpoint. Vulnerability-Stress Model: A modern perspective on schizophrenia that emphasizes the interplay of biological vulnerabilities and environmental stressors in the development of the disorder. NFFMIJ: National Federation of Families with Mentally Ill in Japan, the patient family advocacy group that first requested a less stigmatizing term. Stigma: Negative attitudes, beliefs, and stereotypes that society holds about a group, such as people with mental illness. DALYs: Disability-Adjusted Life Years, a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death. Dementia Praecox: An older term for schizophrenia, reflecting the belief that the disease is characterized by early onset and progressive decline, which is an aspect of the now outdated Kraepelinian view. Psychosocial Interventions: Therapies that address the psychological and social factors affecting mental health, such as social skills training, family therapy, and cognitive behavioral therapy. Inhumane Treatment: The term used to describe the past conditions in Japan where patients with "Seishin Bunretsu Byo" were isolated, restrained, or mistreated.  S4: Enduring issues in diagnostic ethics (Sept 27) Questions for 11. What was the old Japanese term for schizophrenia and what does it literally Review translate to in English? 12. What prompted the Japanese Society of Psychiatry and Neurology (JSPN) to consider renaming schizophrenia? 13. What were two main concerns about the old term for schizophrenia that the Japanese Society of Psychiatry and Neurology wanted to address? 14. What is the new Japanese term for schizophrenia and what does it translate to in English? 15. How did the renaming of schizophrenia relate to the shift from the Kraepelinian concept to the vulnerability-stress model? 16. What was one of the major historical reasons contributing to the stigma associated with the old term for schizophrenia in Japan? 17. According to the research, what was the approximate percentage increase in patients being informed of their diagnosis after the renaming of the disorder in Japan? 18. What was the approximate rate of usage of the new term for schizophrenia in Japanese mental health reports shortly after the official renaming? 19. According to a survey of psychiatrists in the Miyagi Prefecture, what were two benefits of using the new term? 20. What was the framework used to create the Japanese treatment guidelines for schizophrenia after the renaming? Florence Ashley (2019) "Gatekeeping hormone replacement therapy for transgender patients is dehumanising." Summary Argument: against requiring mental health professional assessments for transgender individual seeking hormone replacement therapy (HRT) ○ Gatekeeping is dehumanizing, unethical, based on flawed understanding of gender identity, and violates patient authority Informed consent model ○ Prioritizes patient autonomy ○ Rejects pathologization of transgender identities Desire for HRT can stem from gender euphoria and creative self-expression, not just gender dysphoria