chapter 12: normality, mental health and mental · pdf filechapter 12: normality, mental...

© Macmillan Education Australia 2013 1 VCE Psychology Units 3 & 4 ISBN 978 1 4202 3217 2 │ Digital teacher: 978 1 4202 3242 4

Chapter 12: Normality, mental health and mental illness Learning activity suggested answers Learning Activity 12.1 (p. 472) Discuss student responses to clarify conceptual understanding.

Learning Activity 12.2 (p. 474) 1 Explain the meaning of the term normality with reference to an example.

Explanation should refer to a pattern of thoughts, feelings or behaviour that conforms to a usual, typical or expected standard (within a culture).

2

a Describe two examples not used in the text of normal behaviour in Australian society that may be considered abnormal in another society.

Examples include:

• it is normal in Australia for women to wear bikinis at the beach, unlike Muslim countries where it is not

• it is normal in Australia to have cereal for breakfast ,unlike certain European cultures where cheeses, cold meats, bread rolls, croissants etc. are eaten)

b Describe two examples not used in the text of normal behaviour in a cultural group within Australian society that may be considered abnormal by another cultural group in Australia.

Examples include:

• it is normal for Australian Aboriginal boys who have reached puberty to participate in a week-‐long initiation ceremony called a Corroboree

• it is normal for widows of Italian and Greek ethnicity living in Australia to wear black for the rest of their lives

3

a Explain the meaning of the term abnormality with reference to an example.

Explanation amy refer to :

• thoughts, feelings and behaviour that are not considered normal in the context in which they occur e.g.

• deviance -‐ thoughts, feelings and behaviours that ‘deviate’ or vary markedly from social or cultural norms;

Chapter 12: Normality, mental health and mental illness


• dysfunction: thoughts, feelings or behaviours that interfere with the person’s ability to carry out their usual daily activities in an effective way

Note: a specific answer is not provided in the text.

b Consider the following description of Alessio and explain whether his thoughts, feelings and behaviour are normal with reference to the socio-‐cultural, medical and statistical approaches to defining normality.

Before leaving his house, Alessio checks that all the electrical appliances are unplugged (because he thinks they might start a fire while he’s out), all the taps are completely turned off (because they might flood his house while he’s out) and that ll the doors and windows are properly secured (because he thinks someone might break in while he’s out). On a couple of occasions, Alessio has made several journeys back and forth to his home to check that things are as they should be, because he had a ‘niggling doubt’ that his first check was not done properly. Alessio’s checking behaviour consumes several hours of his day and it has got to the point where he has been late for work so often that he’s just been dismissed. The situation between Alessio and his girlfriend is also strained. Alessio’s girlfriend reports that ‘he has no time for me anymore’. Alessio wants to stop having to ‘check’ things all the time, but if he doesn’t do it he experiences so much anxiety that he is nearly physically sick.

Name of approach

Description of approach Alessio’s behaviour

Socio-‐cultural What a particular society views as acceptable (commonplace) is normal and what is unacceptable (different) is abnormal

Alessio would be considered abnormal from this perspective as it is not acceptable for a person to be late for work because they have to check all of their electrical appliances are unplugged, the taps are completely turned off and that all the doors and windows are properly secured multiple times. Nor is it considered commonplace or acceptable that someone is engaged in checking behaviour for several hours a day.

Medical Abnormal thoughts, feelings or behaviours have an underlying biological cause that is treatable. A person whose thoughts, feelings or behaviour is normal and has no illness.

Alessio would be considered normal from this perspective as no underlying biological cause is likely to be found to explain his thoughts, feelings and behaviour e.g. he would not have an abnormal blood test result, no brain lesions on an MRI would be found etc.

Statistical Normality is how most (the majority) of people think, feel and behave and abnormality is how few people think, feel and behave.

Alessio would be considered abnormal from this perspective as the majority of people do not have the thoughts and feelings that he does and do not behave like he does.



Learning Activity 12.3 (p. 481 ) 1 Explain the meaning of mental health with reference to examples of the thinking, feeling and

behaviour of a mentally healthy person.

Explanation may refer to:

• thinking -‐ logical and clear;

• able to manage feelings/emotions (e.g. no highs and lows over a prolonged period), experience pleasure and enjoyment, and cope with the normal stressors arising in everyday life;

• behaviour -‐are able to form positive relationships with others and use their abilities to reach their potential

2 Explain the meaning of mental illness with reference to an example that illustrates the key elements of the definition, but not an example used in the text.

Explanation should refer to a person with a mental illness not thinking, feeling and/or behaving as they normally do.

Key elements of mental illness include:

• thoughts, feelings, and/or behaviour that impair the ability to cope effectively with everyday life

• the person experiences distress

• thoughts, feelings and/or behaviour that are atypical of the person

• thoughts, feelings and/or behaviour that are atypical of the person’s culture.

3 What are the differences between a mental health problem and a mental illness?

Differences may include:

• amount of distress , impairment in functioning and difficulty in coping

• thoughts, feelings and behaviour in terms of severity and persistence

• treatment and recovery

4 Does abnormal behaviour necessarily indicate the presence of mental illness? Explain your answer.

• Abnormal behaviour alone does not necessarily indicate the presence of mental illness any more than one cough indicates the presence of a physical illness.

• A person can manifest a wide variety of abnormal behaviours (as judged by any definition/approach) but not have a diagnosiable mental illness.

• For example, according to the statistical approach, a person with an IQ of 170 would be considered ‘abnormal’. However, this approach fails to recognise the desirability of the particular characteristic. In addition, this does not necessarily mean that such individuals are suffering from mental illness just because they are ‘abnormal’.

5 Distinguish between mental health and mental illness with reference to an example.

The distinction should refer to differences in levels of:

• functioning/impairment, and



• distress.

For example:

• mental health refers to a person’s capacity to function efficiently and effectively in their daily lives and a mentally healthy person is not experiencing marked distress; whereas,

• mental illness refers to a psychological dysfunction that interferes with a person’s ability to function efficiently and effectively in their daily lives and the person is likely to be experiencing distress.

Learning Activity 12.5 (p. 491) 1 Explain the meaning of the phrase ‘categorical approaches to the classification of mental

disorders’.

Explanation should refer to categorical approaches classifying mental disorders into categories and subcategories, each with symptoms and characteristics that are typical of specific mental conditions and disorders.

2 What are the underlying assumptions and principles of the categorical approach?

Underlying assumptions and principles include:

• there is a clear distinction between what is normal and what is abnormal

• a mental disorder can be diagnosed from specific symptoms reports and/or presented (‘shown’) by a client during a mental health assessment conducted by a qualified mental health professional

• thoughts, feelings and behaviour can be organised into categories representing disorders

• within a disorder category, there exist discrete (‘completely separate’) and distinct (‘clearly different’) subcategories or types of the disorder, each with a characteristic pattern of symptoms that represent that disorder and not any other disorder

• the disorder categories are constructed and organised in such a way to allow for wide variation in patterns of thoughts, feeling and behaviours so that disorders can be diagnosed even if the client does not show the ‘perfect’ or ‘textbook’ disorder pattern;

• there are clear boundaries around each disorder and disorders do not overlap

• an individual either has or doesn’t have a diagnosable mental disorder (‘all or nothing’ principle)

3 Why is it important that categorical approaches are reliable and valid?

Categorical approaches must be reliable because:

• the system/approaches should produce the same diagnosis each time it is used in the same situation;

• different mental health professionals or researchers should independently reach the same diagnosis of the same client (i.e. have good inter-‐rater reliability);

• different clients with the same symptoms should receive the same diagnosis.

Categorical approaches must be valid because:



• the diagnosis given should accurately reflect the mental disorder it is meant to be diagnosing, e.g. the categorical approach should diagnose ‘depression’ if that’s what the client has; if the client has ‘depression’ but the system/approach diagnoses ‘schizophrenia’, then the approach would have poor validity for depression (and probably other disorders as well).

4

a What is the DSM, who is it created for and what is it used for?

• The DSM—Diagnostic and Statistical Manual of Mental Disorders—is a manual (book) that was first published in 1952 by the American Psychiatric Association (APA).

• The DSM uses a categorical approach for diagnosing and classifying mental disorders based on recognisable symptoms that are precisely described for each disorder.

• The DSM is published for use by mental health professionals and researchers.

• The DSM is primarily used to assist in the diagnosis of mental disorders (illnesses) but it also provides information about mental disorders such as course, prevalence etc.

b How many major categories of mental disorders does the current DSM have?

DEM-‐IV-‐TR is not the current DSM but is specified in the study design. This DSM has 16 major categories (plus one additional section called ‘Other conditions that may be a focus of clinical attention)

c What is the common purpose of diagnostic, inclusion, exclusion and polythetic criteria?

The purpose of all of these criteria is to help the mental health professional make a decision about whether or not their client has, or doesn’t have, a particular mental disorder(s).

• Diagnostic criteria indicate the symptoms that are characteristic of the disorder.

• Inclusion criteria are used to identify the symptoms that must be present in order for the disorder to be diagnosed.

• Exclusion criteria are used to identify the symptoms, conditions or circumstances that must not be present (i.e. absent) in order for the disorder to be diagnosed.

• Polythetic criteria is a list of diagnostic criteria in which only some symptoms (not all) need to be present in order for the disorder to be diagnosed.

d Explain the meaning of the terms course and prevalence in relation to a mental disorder.

Course refers to a description of how the disorder is likely to progress during the person’s lifetime, e.g. the symptoms of disorder X may reduce in severity during adulthood or the severity of impairment caused by disorder Y may fluctuate with life stressors and demands.

Prevalence refers to how commonly the disorder occurs(‘prevails’) in various populations, e.g. that phobias affect approximately 1 in 23 or 4.23% or 12.5 million people in the USA.

e Name each of the five axes in the DSM and briefly describe the type of information provided in each axis for classification and/or diagnostic purposes.

• Axis I— Clinical disorders and other conditions that may be a focus of clinical attention: lists the name of the disorder(s) the individual has and always lists the primary disorder first, e.g. Pathological Gambling Disorder and Generalised Anxiety Disorder.



• Axis II—Personality disorders and mental retardation: if the person meets the diagnostic criteria for one of the types of personality disorders listed in the DSM and/or mental retardation they are listed here, e.g. Borderline Personality Disorder.

• Axis III—General medical conditions: provides information about any medical conditions the person has that may be related to the mental disorders in Axis I and II, e.g. a person may have Major Depressive Disorder, which they developed after being diagnosed with breast cancer. Major Depressive Disorder would therefore be listed on Axis I and breast cancer would be recorded here on Axis III.

• Axis IV—Psychosocial and environmental problems: provides information about any potential stressors in an individual’s life that may be relevant to their disorder(s) and is used to identify current and recent stressors impacting on a person’s thoughts, feelings and behaviour that need to be considered when devising a treatment plan, e.g. job redundancy, divorce, eviction from property etc.

• Axis V—Global assessment of functioning (GAF): an overall numerical rating on a 100-‐point scale on which ‘1’ indicates severe impairment in psychological, social and occupational functioning and ‘100’ refers to superior functioning with no symptoms e.g. GAF = 35 (indicating severe impairment).

f What significant information about mental disorders is not provided in the DSM?

Significant information not provided in the DSM includes:

• the aetiology (‘cause’) of the mental disorder and

• how the mental disorder could most effectively be treated.

Learning Activity 12.6 (p. 491) Visual presentation on the DSM

Prepare a flow chart that summarises the procedure for diagnosing and classifying a mental disorder when using the DSM-‐IV-‐TR.

Example:



Learning Activity 12.7 (p. 494) 1

a What is the ICD-‐10, who is it prepared for and what is it used for?

• The ICD-‐10—International Classification of Diseases and Related Health Problems, Tenth Revision (ICD-‐10)—is a manual (book) published by the World Health Organisation (WHO).

• The ICD-‐10 is a categorical system for diagnosing and classifying mental disorders based on recognisable symptoms that are precisely described for each disorder.

Mental health professional conducts an assessment

• takes history of type and duration of symptoms and description of the social and functioning problems caused by the symptoms

• observes client’s behaviour, speech and emotions • administers psychological tests/inventories, e.g. IQ test, personality inventory • obtains collateral information from people who know the client

Mental health professional considers the DSM categories and thinks about which of the mental disorders listed the client’s symptoms most likely falls into

Mental health professional ‘cross checks’ the client’s symptoms with the diagnostic criteria for one (or more) of the mental disorders in the DSM

Mental health professional decides the client’s symptoms do not meet diagnostic criteria for any of the mental disorders listed in the DSM

Mental health professional decides the client’s symptoms do meet diagnostic criteria for 1(or more) of the mental disorders listed in the DSM

Client is given a DSM diagnosis

Client is not given a diagnosis



• The ICD-‐10 is prepared for use by mental health professionals and researchers.

• The ICD-‐10 is primarily used to assist in the diagnosis of mental disorders.

b Name the ICD chapter that specifically relates to mental disorders.

Chapter V (5) International classification of mental and behavioural disorders— Clinical descriptions and diagnostic guidelines

c Name the Australian version of the ICD.

International Classification of Diseases, Tenth Revision, Australian Modification or the ICD-‐10-‐AM

d How many major categories of mental and behavioural disorders does the ICD-‐10 have?

12 categories of mental and behavioural disorders (which are commonly called ‘blocks’)

e What are diagnostic guidelines and what are they used for?

Diagnostic guidelines indicate the symptoms that are characteristic of a disorder.

Their purpose is to help the mental health professional make a decision about whether or not their client has, or doesn’t have, a mental disorder.

2 Construct a table in which you compare key similarities and differences of the DSM and ICD-‐10

Similarities Differences

• both are categorical systems

• both are used to help mental health professionals decide whether or not a person has or doesn’t have a particular mental disorder

both list the symptoms that are characteristic of each mental disorder

• both have multi-‐axial systems available for mental health professionals to use

• both are revised and updated every few years

• both do not specify the causes of each mental disorder

• both do not specify how each mental disorder should be treated

• both have categories and subcategories, e.g. ‘Major Depressive Disorder’ is a subcategory of a larger category called ‘Mood Disorders’

• the ICD is a less-‐detailed categorical system that the DSM, e.g. the ICD typically does not provide information about the course, prognosis and prevalence of each disorder

• the DSM integrates its multi-‐axial system but with the ICD it is in a separate version

• the ICD has a number of different versions (e.g. specifically for researchers), whereas the DSM just has the one version

• the list of symptoms that are characteristic of the disorder are called ‘diagnostic criteria’ in the DSM and ‘diagnostic guidelines’ in the ICD

• the number of categories differs (ICD = 12 vs. the DSM = 16 plus 1 additional category)

• each mental disorder in the ICD has an alpha-‐numerical ‘F’ code

• the ICD-‐10 has 21 chapters covering the whole of medical practice and mental disorders are included in Chapter V



Learning Activity 12.8 (p. 494) Visual presentation on the ICD-‐10

Prepare a flow chart that summarises the procedure for diagnosing and classifying a mental and/or

behavioural disorder when using the ICD-‐10.

Learning Activity 12.9 (p. 502) 1 Explain the meaning of the phrase ‘dimensional approach to the classification of mental

disorders’.

Explanation should refer to:

Mental health professional conducts an assessment

• takes history of type and duration of symptoms and description of the social and functioning problems caused by the symptoms

• observes client’s behaviour, speech and emotions • administers psychological tests/inventories, e.g. IQ test, personality inventory • obtains collateral information from people who know the client

Mental health professional considers the DSM categories and thinks about which of the mental disorders listed the client’s symptoms most likely falls into

Mental health professional ‘cross checks’ the client’s symptoms with the diagnostic criteria for one (or more) of the mental disorders in the DSM

Mental health professional decides the client’s symptoms do not meet diagnostic criteria for any of the mental disorders listed in the DSM

Mental health professional decides the client’s symptoms do meet diagnostic criteria for 1(or more) of the mental disorders listed in the DSM

Client is given a DSM diagnosis

Client is not given a diagnosis



• classifying mental disorders by quantifying the severity/intensity of symptoms (or other characteristics of interest) with numerical values on one or more scales or continuums;

• classification being accomplished by assessing a person on relevant dimensions and giving them a score/rating on each of the dimensions;

• scores on each dimension often converted into/graphically represented as a profile ;

• lower scores on a dimension(s) are usually associated with lower impairment and higher scores are usually associated with more impairment.

2 What are the underlying assumptions and principles of the dimensional approach? Explain with reference to examples.

Underlying assumptions and principles of the dimensional approach include:

• normality and abnormality are end points on the same continuum without a clear dividing line between them, i.e. there is no clear distinction between what is ‘normal’ and what is ‘abnormal’;

• the concept of ‘mental disorder ’ is not valid so mental disorders do not exist—the symptoms of so-‐called ‘mental disorders’ are just extreme variations of traits or behaviours that we all possess to varying degrees;

• no one should be given a ‘label’, e.g. ‘personality disorder’—they should instead simply be described as people who have relatively extreme and maladaptive variants of the personality traits that are evident within all people.

Discuss student examples to clarify conceptual understanding.

3 What is a profile and what does it indicate about dimensions?

A profile is a graphical representation of an individual’s scores on the dimensions that are measured.

What a profile indicates about dimensions:

• each individual will have a different profile of low or high scores on the various dimensions, i.e. a different profile;

• profiles reflect the uniqueness of each individual’s pattern of thoughts, feelings and behaviours;

• dimensions can be ‘graded’.

4 Explain the meaning of the phrase ‘dimensions can be graded’.


• dimensions being able to be assigned numerical values (i.e. ‘scores’) which reflect the magnitude, degree or severity of a person’s behaviour or traits or characteristics or functioning (from absent to severe);

• a person’s behaviour or symptoms or characteristics or functioning being able to be rated or quantified on one or more dimensions which yields a profile;

• lower ratings on a dimension(s) usually being associated with lower impairment and higher scores usually being associated with more impairment.

5 Give an example of a dimensional approach and explain why it is dimensional rather than categorical.



Examples:

• Eysenck Personality Questionnaire—Revised (EPQ-‐R): a questionnaire/inventory for people aged 18 and over designed to measure three dimensions of personality called extraversion–introversion, neuroticism–emotional stability and psychoticism. Following completion, the scores on each dimension are graphed and lines are drawn to show the person’s profile.

The EPQ-‐R is dimensional and not categorical is because it does not tell the mental health professional whether or not the respondent has a 'personality disorder', i.e. whether they meet the diagnostic criteria for one of the personality disorders listed in either the DSM or ICD, it provides a profile of scores.

• Minnesota Multiphasic Personality Inventorn—2nd edition (MMPI-‐II)—a questionnaire/inventory for people aged 18 and over designed to measure ten different dimensions of personality such as hysteria, psychopathic deviancy and social introversion. Following completion, the scores on each dimension are graphed and lines are drawn to show the person’s profile.

The MMPI-‐II is dimensional and not categorical is because it does not tell the mental health professional whether or not the respondent has a 'personality disorder' i.e. whether they meet the diagnostic criteria for one of the personality disorders listed in either the DSM or ICD, it provides a profile of scores.

• Conners Parent and Teacher Rating Scales—Third Edition (CRS-‐III): paper-‐and-‐pencil questionnaires for which parents and teachers are asked to rate a child on a number of different statements ranging from not true at all (0) through to very much true (3). The statements are clustered onto a number of different dimensions e.g. hyperactivity dimension, anxiety dimension, peer relationships dimension, attention/concentration dimension. Following completion, the scores on each dimension are graphed and lines are drawn to show the child’s profile.

The CRS-‐III is dimensional and not categorical is because it does not tell the mental health professional whether or not the child has Attention Deficit Hyperactivity Disorder (ADHD) or not, i.e. whether the child meets the diagnostic criteria for ADHD listed in the DSM (or ‘hyperkinetic disorder’ listed in the ICD), it provides a profile of scores.

6 Give an example of how a dimensional and categorical approach could be used together.

Example:

• A mental health professional conducts a clinical interview and use a categorical approach to decide whether or not the person meets diagnostic criteria for Major Depressive Disorder as listed in the DSM-‐IV-‐TR.

• They decide that their client does meet the diagnostic criteria for Major Depressive Disorder so their client is therefore diagnosed with Major Depression and considered to be ‘in’ the major depression category.

• the client is asked to to complete an inventory for assessing depression

• the client’s scores categorised as either mild (e.g. 0–15), moderate (e.g. 15–30) or severe (e.g. 30+).

7 Describe two strengths and two limitations of dimensional approaches to classification of mental disorders.



Strengths include:

• Dimensional approaches can potentially eliminate stigma as they eliminate the use of labels such as ‘schizophrenic’ and ‘manic-‐depressive’ which have acquired potentially harmful connotations.

• Dimensional approaches communicate more clinical information, i.e. they take into account the full range of clients’ behaviour and provide a fuller description (‘profile’) versus just a summary of what a client ‘has’ or ‘doesn’t have’ like categorical approaches do.

• Dimensional approaches can more accurately represent some disorders, particularly those that have symptoms which are considered to be ‘on a continuum’, i.e. are considered to be extremes of traits or characteristics we all possess to some degree, e.g. everyone has a ‘personality’ and there are differences in ‘how much’ of each trait or characteristic we each possess (how much ‘extroversion’ we each possess, how much ‘neuroticism’ we each possess, and so on).

Limitations include:

• Dimensional approaches are less ‘familiar’ than categorical approaches (which have been around since the 1800s).

• Dimensional approaches can be more difficult and time consuming in normal everyday clinical practice to use (e.g. a mental health professional may have to rate client on as many as 40 dimensions as opposed to making a yes/no decision like categorical approaches require).

• At present, it is difficult to determine which dimensions are most useful in clinical practice and accessible to measurement.

Learning Activity 12.10 (p. 502) Summarising categorical and dimensional approaches

Complete the following table to summarise the categorical and dimensional approaches to classification of mental disorders.

Criteria Categorical Dimensional

Definition approaches to classifying mental illnesses into distinct categories on the basis of their similarities

approaches that quantify a person’s symptoms or characteristics on one or dimensions rather than assigning them to a category

Principles and assumptions

• normality and abnormality are distinctly different from each other

• thoughts/feelings/behaviour can be organised into categories representing distinct disorders

• there are clear boundaries around each disorder and no disorders

• normality and abnormality are end points on the same continuum with no clear dividing line between them

• the symptoms of mental disorders are just extreme variations of traits or behaviours that we all possess to some degree



overlap

• a person either has or does not have a diagnosable mental disorder (all-‐or-‐nothing principle)

• good reliability and validity

• no one is given a ‘label’ of any disorder (e.g. personality disorder)—they would instead simply be described as people who have relatively extreme and maladaptive variants of the personality traits that are evident within all people

Examples DSM-‐IV-‐TR and ICD-‐10 EPQ-‐R, MMPI-‐2, CRS-‐III

Strengths • contributes to the scientific literature/research and teaching about mental disorders

• facilitates communication

• user-‐friendly

• familiar

• high inter-‐rater reliability particularly for some disorders (e.g. psychotic disorders)

• is consistent with clinical decision-‐making e.g. does this person need to be admitted to hospital? (Yes/No answer)

• eliminates the use of labels such as ‘schizophrenic’ which have acquired potentially harmful connotations (i.e. reduces stigma)

• communicates more clinical information—takes into account the full range of clients’ behaviour and provides a fuller description (‘profile’) versus just a summary of what a client ‘has’ or ‘doesn’t have’

• some disorders may be more accurately represented because they are extremes of normal human characteristics, e.g. personality, mood and anxiety disorders, ADHD

Limitations • low inter-‐rater reliability for some disorders (e.g. personality disorders)

• the amount of overlap between disorders sometimes make it difficult to know which category (disorder) a client’s symptoms belong to

• loss of valuable clinical information

• labeling/stigma

• the use of polythetic criteria means that it is possible for two people to be diagnosed with the same disorder (e.g. obsessive compulsive personality disorder, schizophrenia) but they not share a single symptom—this does not seem logical or very scientific

• less familiar

• more difficult and time consuming in normal everyday clinical practice (e.g. mental health professional may have to rate client on as many as 40 dimensions)

• difficult to determine which dimensions are most useful and accessible to measurement



Learning Activity 12.11 (p. 504) 1 What is the biopsychosocial framework?

The biopsychosocial framework (or biospsychosocial model or theory) is an approach to describing and explaining how:

• biological, psychological and social factors

• combine and interact

• to influence a person’s mental and physical health.

2

a Name and describe the three domains in the biopsychosocial framework with reference to relevant examples.

Answer should include description and examples:

• Biological (‘bio’) factors – biologically/physiologically based or determined influences e.g. genes, neurochemistry.

• Psychological (‘psycho’) factors – all those influences associated with mental processes e.g. how we think; learn; make decisions; solve problems.

• Social (‘social’) factors – our skills in interacting with others, the range and quality of our social relationships as well as cultural traditions and values, socio-‐economic status etc.

b For each domain, give two additional examples of factors not referred to in the text.

Discuss student answers and clarify conceptual understanding, particularly the distinction between psychological and social factors.

c Give an example of a factor that you believe does not clearly belong within a specific domain or may be relevant to more than one domain. Explain your choice.

Discuss student answers and clarify conceptual understanding, particularly the distinction between psychological and social factors.

3 Briefly describe three key characteristics of the biopsychosocial framework’s explanation of physical and mental health.

Characteristics of the biopsychosocial framework’s explanation may include:

• takes a holistic view of physical and mental health (the individual should be considered as a ‘whole person’ functioning in their unique environment)

• does not just focus on the individuals’ physical or mental condition (“within” the individual), but it also focuses on their wider social context or circumstances (“outside” the individual)

• views each of the three domains as equally important for both physical and mental health i.e. focussing on the influence of factors from one or two domains, rather than all three is likely to give an incomplete (and therefore inaccurate) picture of a person’s health

• recognises that specific factors may have more or less influence on an individuals’ physical and mental health



• recognises that factors often combine and interact in a complex way which helps to account for the individual differences in health, and conversely, the experience of illness and disease.

4 Give a reason to explain why the biopsychosocial framework may also be described as a model or theory.

Explanation should demonstrate understanding of the biopsychosocial framework as a relatively recent, widely adopted theory/model for describing and explaining mental/physical health/illness/management/treatment but there are also other approaches (e.g. statistical, psychodynamic).

As with most other models and theories, it is judged primarily byits usefulness in assisting understanding and by empirical evidence supporting principles/assumptions.

5 Consider a recent time when you were physically ill or feeling stressed. You do not have to name the illness or the source of your stress. Make a copy of the following table and identify factors within each domain that may have contributed to a. the onset of the illness or stress and b. recovery from the illness or stress.

The focus should be on clarifying the biopsychosocial framework. Remember to respect condfidentiality and to be sensitive to public disclosure of student answers involving personal revelations.

6 Write a series of questions a doctor or psychologist who has adopted the biopsychosocial framework may ask a patient or client presenting with symptoms of a physical or a mental health problem.

Questions should cover all three domains e.g.

• Biological – What are your current physical health problems? How long have you had these problems? Are you taking any medications? How would you describe your overall level of fitness? What is your current height and weight? Do you smoke or drink alcohol? If so, in what quantities? Do you have any allergies?

• Psychological – On scale of 1-‐10, where 1 is the worst you’ve ever felt and 10 is the best you’ve ever felt, how are you currently feeling? Do you have any stressors in your life at the moment? Generally speaking, how do you cope with stress? How well do you think you are coping at the moment?

• Social – What is your current marital status? Do you feel you have enough social support from friends and family? What is your current employment status? Do you have any financial difficulties?

7 To what extent are the DSM’s multi-‐axial system and ICD-‐10 approach to diagnosing mental and behavioural disorders consistent with the biopsychosocial framework? Explain your answer with reference to key characteristics of the DSM, ICD and biopsychosocial framework.


• both the biopsychosocial framework and DSM’s multi-‐axial system take a holistic approach and considers the ‘whole person’

• both the biopsychosocial framework and DSM acknowledge that biological, psychological and social factors combine and interact to affect a person’s physical and mental health status. For example:



• the DSM’s multi-‐axial system recognises that biological factors can influence a person’s mental health, this is acknowledged on Axis III-‐ General Medical Conditions

• the DSM’s multi-‐axial system recognises that psychological factors can influence a person’s mental health, this is acknowledged on Axis I – Clinical disorders and Axis II – Personality Disorders and Mental Retardation

• the DSM’s multi-‐axial system recognises that social factors can influence a person’s mental health, this is acknowledged on Axis IV-‐ Psychosocial and environmental problems.

• the DSM’s multi-‐axial system recognises that mental and physical illnesses can influence a person’s functioning and this is acknowledged on Axis V – GAF.

Learning Activity 12.12 (p. 505) Visual presentation on the biopsychosocial framework

Construct a diagram different to that in Figure 12.26 to represent the biopsychosocial framework’s approach to describing and explaining physical and mental health. In your diagram:

• show the relationship between the domains

• show possible relationships between different factors within each domain

• include examples of factors in addition to those described in the text

Beneath your diagram, write a caption that briefly describes the framework and how it explains physical and mental health.

Example:



• Examples of factors in addition to those described in the text:

Biological factors – infections, diseases, brain trauma, medication, drugs and alcohol, diet, brain structure

Psychological factors – temperament/personality, level of self-‐esteem, coping and thinking style, outlook on life (pessimistic vs. optimistic), locus of control

Social factors – life events and trauma, poverty, homelessness, social isolation, immigration, employment demands, lifestyle.

• Example of the possible relationships between different factors within each domain:

Mr Graham is experiencing immense demands in his job requiring him to work extremely long hours. Because he is working such long hours there is no time to see any of his friends or family anymore, no time to exercise, and no time to cook (so he eats take-‐away meals high in fat and salt). Mr Graham has also started drinking a lot of alcohol. As a result of his increasingly poor diet, nil physical exercise and high alcohol intake, he has started experiencing some physical health problems. Without the support of any friends of family, Mr Graham has begun to feel low in mood and that he is helpless to do anything about his situation.

• Example of caption:

The biopsychosocial framework is a way of understanding how biological, psychological and social factors combine and interact to influence a person’s physical and mental health status.

Social factors

Psychological factors

Biological factors

chapter 12: normality, mental health and mental · pdf filechapter 12: normality, mental...

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