Separate but Equal, Coursework Example

The Medical, Psychological, and Sociological Factors of Mental Health

Assessment Item 1

The consideration of medical, psychological, and sociological perspectives of mental health confirm that there is a significant amount of stigma attached to seeking treatment- a black mark on the permanent health record, if you will. Suddenly the world revolves around some enigmatical disorder; even the word “disorder” implies a swirling chaos of negative implications for the patient.

Part 1: Theoretical Perspectives

Medical

The United States National Institute of Mental Health (NIMH) conducted a census of 20,000 Americans; as a result of this informative data, one in every six Americans is said to suffer from a clinical mental disorder (as of 2002). The same rates apply for Britain and Australia within the same three-year period. In 2000, the prevalence of abnormal mental health in Australian adolescents was statistically one in seven (Myers 2005). It is clear that there is a global similarity for issues of mental health and hence a need for a standardized view, but with such a view come limitations of perspective.

Causes

Because medical diagnoses in mental health emphasize what is physically lacking in the patient, the general assumption is that the body is in control of all happenings within the body and that an error in the physicality can be attributed to every abnormality. As such, the interconnection of bodily factors is responsible for mental health also.

The medical fields focus first on the functions of the brain, as does Doctor Daniel Amen’s Change Your Brain Change Your Life. The brain itself is no simple organ; it is a complex labyrinth of individual areas with separate purposes. Understanding the individual purposes of each portion of the brain helps doctors understand mental health from a purely medical standpoint. For example, the deep limbic center is the root of subtle intricacies, such as mood changes and emotional bonding, which is a regular contributor to mental disorder in otherwise-healthy patients. The basal ganglia create anxiety and avoidance; the prefrontal cortex polices impulse and morality; the cingulated aids in multitasking; the temporal lobe contains impulse recognition, feedback, and response (Amen 1998).

One patient, Andrew, had been a personal acquaintance of author Daniel Amen. At the age of nine, Andrew began to linger on homicidal and suicidal thoughts. When his parents brought their son to Dr. Amen he conducted a scan of Andrew’s brain which revealed that his left temporal lobe had been replaced by large cyst in his brain. However, one pediatric specialist after another told Dr. Amen that they would not operate on the child until he developed “real symptoms… like seizures or speech problems” (Amen 1998, 12-13). However, when the cyst which dominated Andrew’s temporal lobe was removed, Andrew returned to his normal, carefree status of a child (Amen 1998).

This is an example which illustrates how useful the examination of the brain can be, but there are indeed other important medical factors which bear upon behavior. In Andrew’s example, his aggression was caused by a temporal lobe cyst, but research reveals that genetic, biochemical, and other neural influences, i.e. head injury or a shock, can also provoke extreme hostility. Aggression presents a unique challenge to medical theorists, because “no one spot in the brain controls aggression…[it] is a complex behavior that occurs in particular contexts” (Myers 2005, 625).

Treatment

The biomedical treatment options are antipsychotic, antianxiety, and/ or antidepressant drugs, electroconvulsive therapy (ECT), or psychosurgery. All medicinal treatment plans require careful monitoring, precise prescriptions, training, and an active support system to perform at their fullest capacity. This is the closest cooperation between the different realms of the mental health system. Since its introduction in 1938, ECT has met with ambivalence from the public sector and with reservations from the medical sector. Although it is depicted as brutal and dehumanizing-even “Frankensteinlike”- psychiatrists and therapists agree that it is an acceptable bargain for patient cases involving a significant suicide risk. Medicine’s best guess is that the shock’s energization reactivates the left frontal lobe and restores normal brain functioning (Myers 2005).

However, unlike the other purely medical approaches to mental disorders, psychosurgery is irreversible. It often involves a lobotomy. This process involves inducing a coma, hammering a pick through the eye sockets, and wiggling the hammer around in the area of the frontal lobe of the brain. This approach often irreparably stunts emotional growth. It has rarely been used since it was largely replaced by the other methods (Myers 2005).

Despite a propensity for drastic measures, the medical community is skeptical about simple herbal solutions, such as Hypericum perforatum. The wonder-herb, commonly called Lamath weed, goat weed, or (most commonly) St. John’s wort, is commonly found on all continents except for Antarctica and is taken twice a day by at least twenty million people in Germany to treat all-but-severe cases of depression as part of their health insurance (Zuess 1998; Null 2005). During Britain’s clinical trials, doctors and patients were not informed which samples were placebos, prescriptions, or St. John’s wort, and the results revealed that St. John’s wort was remarkably effective- even moreso than the prescription drug imipramine (Zuess 1998). Gingko Biloba is commonly used to improve the capacity of the memory.

Psychological

Douglas Bloch’s (2002) components of psychological self-care consist of restructuring, practicing, feeling, thinking, working, taming, overcoming, releasing, and healing in a more positive and constructive way and provide a new psychological perspective through which the patient will practice seeing himself (p. x).

Critics of this approach have pointed out that coincidences may be attributed to success of treatment, positivity in the patient can produce a placebo effect, extremes tend to regress with time, patients feel the need to justify money and time spent with a result, and personal, warm-hearted opinions of therapists often lead patients to “sugar-coat” the potential benefits of therapy (Myers 2005). These are the reasons which lead the mental health professional to conclude that appropriate psychotherapy in mild to severe mental conditions is a necessary bonding exercise in the development of natural alternatives to medicine alone.

Psychotherapy

There is a vast array of different approaches and cut-and-paste personalizations of therapeutic theory which emphasize various aspects of the human experience. Psychotherapy itself combines many factors that pertain to the medical, biological, psychological, sociological, economic, personal, philosophical, and progressive spheres. For our initial example we will discuss the quirks of humanistic therapy. Arguably one of the most unique psychotherapeutic approaches, humanistic therapy focuses on the client, the present, the future, and being nondirective. Basically, the patient is not given direction regarding topic or insight, except to take responsibility and let their minds freely wander from their unconscious to conscious thoughts. Note the distinction between ‘client’ and ‘patient’. The therapist is guided by the rules of paraphrasing, inviting clarification, and reflecting feelings, which is particularly important in the case study of Farmer Bill later in this paper (Myers 2005).

Another common approach is related to behavior and the use of classical conditioning techniques, such as the famous Pavlovian dog experiment. This involves pairing a stimulus with a conditioned response- either positive or negative. Positive conditioning is known as systematic desensitization; negative conditioning is known as aversive conditioning. Result-based conditioning is known as operant conditioning (Myers 2005).

Systematic desensitization is the slow and gradual replacement of a negative association with a positive one. A common systematic desensitization in parenthood is buying your academically-resistant child ice cream each day that he goes to school. For the child, the educational experience is negative and being associated with the positive motivation, ice cream.         Aversive conditioning associates a negative result with a negative stimulus. People who- in times of illness- become sick often develop an aversive conditioning to the food that they ate when they were last sick. Operant conditioning, on the other hand, would suggest that consumers avoid any food consumed during the last couple of days before the sickness (Myers 2005).

Other notable psychotherapeutic approaches include the psychodynamic, cognitive-behavioral, interpersonal, and logotherapeutic approaches. The psychodynamic approach draws on the theories of Freud, Jung, and Adler to analyze depression and other mental conditions through the perspective of past problems, conflicts, relationships, and even dreams. In this approach, the emphasis is placed upon releasing repressed memories and feelings and, consequently, requires a great level of trust and comfort between the patient and doctor. The cognitive-behavioral approach, on the other hand, teaches the importance of thought patterns in developing a positive reservoir of thoughts to combat the negativity of depression and other mood disorders. This approach rationally criticizes the faulty logic which accompanies heightened emotion and advocates simple physical activity as a method of releasing tensions in a therapeutic response. The interpersonal approach examines the patient’s relationships with other people and emphasizes techniques which build healthy connections and provide a social network of support. The logotherapeutic approach developed by Victor Frankl is a popular European existential approach which focuses on the meaning of life and each person’s part in that meaning and their sense of self-worth (Bloch 2002).

Classification of Strengths

The DSM is the abbreviation of the Diagnostic and Statistic Method of Mental Disorders, and it is widely held to be one of the most reliable medical guides to the identification and treatment of mental disorders. In “The ‘UnDSM’- A Diagnostic Manual of Human Strenghts”, we are introduced to the Values in Action Classification of Strengths (VIA), the response to the absence of positivity in current pathological approaches. The VIA manual explores cross-cultural strategies “orders and defines human strengths- thinking-feeling-action tendencies that contribute to the good life”—not weaknesses (Myers 2005, 525). These strategic cross-cultural divisions are comprised of wisdom and knowledge, overcoming opposition, love, justice, temperance, and transcendence. Within these large categories are 24 subdivisions: curiosity, a desire to learn, open-mindedness and the ability to judge for oneself, creativity, wisdom, bravery, perseverance, integrity, vitality, kindness, intimacy, social intelligence, citizenship and teamwork, fairness, leadership, humility, self-control, cautiousness, forgiveness, wonder at the small things, gratitude, optimism, playfulness and humor, and spirituality and purpose (Myers 2005).

Sociological

“Learning can alter natural reactions” (Myers 2005, 627). With the rise of the nature versus nurture debate came the rise of the study of the effect(s) of exposure to different norms. In today’s media, sex, aggression, violence, and degradation have all been depicted as essentially related, but the relation has been strengthened by the frequency of overlapping depictions, such as in the examples of rape, sadism, and “rough sex” (Myers 2005). In the same way, sociological theory searches the wider range of culture for possible patterns which may contribute to or cause certain psychological conditions. “Learning can alter natural reactions”, and natural reactions can alter mental health.

Religion

Religion has long been estranged from accepted medical care. This is an especially sensitive area in mental health conditions, because the very nature of these conditions often causes odd sensations of godliness, invincibility, or heightened status, such as in cases where schizophrenic patients believe that the voices that they hear are instructions or communication from a divinity, to name but a few. For obvious reasons, the relationship of religion, therapy, and mental health is both mutually beneficial and tenuous. The matter of personal religious preferences aside, therapy seeks to convince the patient that they are not the right hand of God. This can be complicated by religious fanaticism (Myers 2005; Raab 2007). Many of the prominent religious leaders and writers fit neatly into the folds of either manic depression or schizophrenia; Shadow Syndromes cites the examples of such prominent historical figures as Martin Luther, George Fox, Sabbatai Sevi, and Emmanual Swedenborg. Interestingly, William James viewed religious ecstasy as a matter more of temperament than mental illness (Raab 2007).

Stigmatization

The printed media has by and large focused on the negative aspects of mental illness as representative of the entire scope of the gray shades of psychopathology and repeatedly portrayed any form of mental illness as a predisposition to “violence, failure, and unpredictability” (Nairn, Cloverdale, & Claussen 2001,254). In the 1990’s the issue was brought to the public forefront by several homicides which received national media attention. Not only was the public afraid, they were outspoken in their cry for a more efficient health care for the mentally ill (Hallam 2002). While the funding and public support for mental health care is a positive effect of trials, the long-term effect is that the sociological pressure asserted by the public demands actions which address specific cases rather than the underlying problems.

Two of the most influential cases of mental health were those of Christopher Clunis and Ben Silcock, two schizophrenic patients who had been refused further treatment in London in 1992. Clunis murdered a man without provocation; Silcock was killed when he climbed in with the lions at the city’s zoo. These two tragic cases are typical of unchecked paranoia, overreaction, and- as the Chapman Psychosis Proneness Scale phrases it- “Magical Ideation and Perceptual Aberration” associated with most schizotypal disorders (Hallam 2002; Tackett et al. 2009). In that same year (1992) in New Zealand, the Mental Health (Compulsory Assessment and Treatment) Act required a large-scale release of patient from secure mental health locations. In February of 1997 one of these patience was arrested for “an act of violence against a child” (Nairn et al. 2001).

In a study of independently-contracted clippings from New Zealand public printed media, literature involving mental health, patients, and related subjects was collected from February 3, 1997, to March 2, 1997. The case of child abuse that was mentioned above was included. Of the fifty newspaper articles on the subject, twenty were critical examinations of the occurrence and other subjective evaluations regarding the events. The study also found that the media coverage of mental health patients tended to focus on human rights, vulnerability, risk of dangerousness and threat, and mental illness. There were no pieces of positivity or empowerment during that month-long period (Nairn et al. 2001).

 Reflections on Perspectives

The most common suggestions for treatment are talking or electroshock therapies in combination with medicine. Solomon scolds the mental health field for its lack of clarity and cohesiveness and its common view that treatment is “a one-or-the-other” occurrence (Solomon 2001, 101). The 1999 White House fact sheet also takes such a single-minded view, stating that such psychopathologies “are diagnosable disorders of the brain” (Myers 2005, 524). In Healing from Depression, Douglas Bloch relates his personal account of his experiences and the partitions that are often placed between the medical, psychological, and sociological arenas which affect mental health patients. At one point, he told a therapist that his severe anxiety disorder placed his responses beyond his control while he was undermedicated. They responded by forcing “quiet time” upon him in a padded cell and straightjacket- clearly stating what their impression of his psychological state was. Still, he had not officially been branded crazy. His psychiatrist asked of him “are you afraid that if these symptoms persist, you will become chronically mentally ill?” (Bloch 2002, 16-17). Bloch met with the skepticism of the medical community, the easy fixes of the psychological community, and the stigmatization of the labels that accompany mental health treatment.

We all have our individual flaws. In the sixth edition of the textbook Exploring Psychology the assertion is made that talking therapy assumes that mental health involves talking patients through their abnormality and treating them for their specific labeled condition- instead of focusing on proactive solutions or those of wider scope (Myers 2005, 588). Exploring Psychology iterates that “one way we simplify our world is to categorize” (Myers 2005, 623). The problem with simplification is that it is easily overdone. People are just that- people.

Part 2: Summary of Recommendations for Case Study

Notes

The client, “Farmer Bill”, is recently separated or divorced with children. He is now faced with the estrangement from his wife and only sees his children on the weekends. He blames the system for the custodial limitations. The patient has admitted to considering suicide on average three times a week and rates his risk as a six on a scale of one to ten, with ten being the highest level of risk. He stated that he “can’t see much of a future” without his children. He reported no history of suicidal thoughts, plans, or actions.

His father knows about the suicidal preoccupation. Bill’s father, mother, and friends are his current (adult) support network. He planned to shoot himself and has the gun handy. He sees suicide as a method of ending pain- not life. His motivations for perseverance are his mother and father, his friends, his dog, and his religious beliefs. The session concludes with a no-harm promise to extend from the time of the current interview until the next appointment in a week’s time. The gun will be locked away under Bill’s father’s supervision during that time. Situational depression is serious, and “death by firearms is the fastest growing method of suicide”, according to Bloch (2002, 359).

Rationale

Typically the patient should come with as many of the people in their support group as possible to develop a care plan which is individually suited to the patient and their support system (AHMAC 2002). During this support consult, the diagnosis of situational depression would be revealed along with information, treatment options, and a plan of action. The clearer the expectations for the support system, the patient, and the medical professional, the more likely it is that the execution of these preventive measures will be effective.

Because the patient indicates a current status of severe situational depression, the social-cognitive perspective of therapy and research bears particular relevance to the patient’s case. Studying the reactions of people in similar circumstances is often a good predictor and starting point from which to proceed with the development of the plan of action. It also stresses to the support system the importance of trying to maintain a positive and active environment which appreciates Bill’s personality for his sorrows as well as his joys.

The factors of the patient’s mental fortitude and social preference will be needed before the support consult. There are several ways to obtain this information. One easily understood depiction is the graphing of the Eysenck Personality Questionnaire, which measures levels of stability and instability as well as introversion and extroversion. Another common personality inventory is the Minnesota Multiphasic Personality Inventory.

“Today’s common currency for personality psychology, the Big Five,” is a simple dimensional personality scale which measures factors taken from several different personality inventories and theories (Myers 2005, 496-497). It measures emotional stability as it consists of the range between calm and anxious, secure and insecure, self-satisfied and self-pitying; It measures extraversion as it consists of the range between sociable and retiring, fun-loving, and sober, and affectionate, and reserved; It measures openness as it consists of the range between imaginative and practical, for variety and for routine, and independent and conforming; It measures agreeableness as it consists of the range between soft-hearted and ruthless, trusting and suspicious, helpful and uncooperative; and, finally, It measures conscientiousness as it consists of the range between organized and disorganized careful and careless, and disciplined and impulsive (Myers 2005). It is flexible enough to also measure the patient’s personality shifts for the better or worse, for improvement or for further mental examination.

More specific information regarding religious affiliation- or lack thereof- will be crucial to the approach of any psychotherapy. Despite the personal misgivings and slippery slope of combining diverse personal religious principles with the proven and standardized procedures of the mental health care system, medical fields look kindly on ‘‘the use of religious beliefs or behaviours to facilitate problem-solving to prevent or alleviate the negative emotional consequences of stressful life circumstances’’ (as cited by Raab 2007, 477). Pargament, Smith, Koenig, & Perez (1998) found that religious coping utilizes many different perspectives which involve (more commonly) positive methods and negative methods alike (Raab 477).  The positive outcome correlation that has been established between religious affiliation and religious coping could provide a useful tool for motivation and further understanding of the patient’s psychosocial perspective.

Bill says he is “going” to shoot himself, implying an indifference to therapy and an expectation of failure and the eminent commission of the suicidal act. When the counselor refers to the difficulties of the present and the hopefulness of the future, the client ignores all positive aspects of the counselor’s question. Dr. Amen claims that these “always/ never” thinking statements, or ANTs, are a possible indicator of a deep limbic malfunction, along with other common manifestations, such as focusing on the negative, fortune-telling, mind reading, thinking with your feelings, guilt beating, labeling, personalizing, and blaming. Amen writes that the negative, fortune-telling, mind reading, and blaming manifestations are especially harmful (Amen 1998, 60-64). In severe cases of situational depression, such as that of Farmer Bill, emphasis on the past-present-future continuum is essential to mindful therapy or other mental health sessions. Bloch suggests that the mental health professional introduce this simple phrase to reiterate the importance of perspective: “This, too, shall pass” (Bloch 2002, 392).

“Early detection and early intervention may minimise an episode and enable an early return to optimal wellbeing and functioning,” wrote the AHMAC National Mental Health Working Group (2002, 25). At the conclusion of the therapy session, Bill stated that “this was really helpful and I feel a lot clearer in my head and I feel a lot better, I didn’t think this counseling [expletive] would help but I think it has”.

The patient has been provided with one suicide hotline telephone number. In the future, several telephone hotline numbers should be given. (A long busy signal can worsen the impatience of a suicidal patient.) Several suicide hotline contacts include: the American Suicide Survival Line at 888-SUICIDE, the Samaritans Suicide Hotline at 212-673-3000 or [email protected], the Covenant House Nineline at 800-999-9999, the Suicide Awareness Vocies of Education (SAVE) at www.save.org/index.html, and the website www.metanoia.org/suicide/  (Bloch 2002).

For the week following that appointment, Bill is at low risk for committing suicide, because he will be with friends. He is at greatest risk when his alone, because he again feels powerless to affect his own happiness. Pliny wrote that the ability to take one’s own life is one of the best divine gifts. With all due respect to Pliny, the field of social work argues that the ability to not take one’s own life has greater merit (as cited by Solomon 2001, 246).

Assessment Item 2

Case Study 1

Michael shows symptoms of psychosis, such as withdrawal, paranoia, moodiness, and his abusive relationship with his parents. After a careful review of his health record, the recommended course of action is to proceed with the screening process. One effective

tool used to screen for psychosis is the Dimensional Assessment for Personal Pathology- Basic Questionnaire (DAPP-BQ). With a total of 290 items regarding various aspects of 18 different personal pathological components, the DAPP- BQ can confirm the diagnosis, suggest possible alternative diagnoses, or altogether debunk assumptions that were made regarding the seriousness and permanency of Michael’s condition (Tackett, Silberschmidt, Krueger, & Sponheim 2009).

In the similar case of Derrick in Change Your Brain Change Your Life, He was anxious, tearful, paranoid, sleepless, avoidant and suspicious of his peers. He also considered suicide as a way to end his feelings of social inadequacy and pain. For Derrick, psychotherapy had produced no measurable results. Antidepressants and antipsychotic prescriptions also met with no success- except to further narrow the treatment options available (Amen 1998).

After less aggressive psychotherapeutic approaches and prescription regimens are initiated, a psychiatrist’s next step is to evaluate the function and form of cognition. His SPECT scan show lower levels of activity in the prefrontal cortex of the brain. When Dr. Amen turned to alternative medicine, Derrick showed marked levels of improvement and soon needed only occasional routine psychotherapy and psychiatry in combination with his alternative medicine regimen. His prefrontal cortex had even returned to normal levels (Amen 1998).

Any progress made is all for naught if the patient cannot or will not abstain from any use of drugs or consumption of alcohol. Michael is using cocaine regularly. If he is not addicted already, he is likely to become so soon. Potential for addiction aside, the euphoria of a stimulant in a young man who has been hearing voices is a recipe for a mental collision. As Michael comes off of his brief, fifteen to thirty-minute high, he is likely to feel depressed by the lack of dopamine, serotonin, and adrenaline. Long term effects may include emotional disturbance, suspiciousness, convulsions, cardiac arrest, or respiratory failure, according to Exploring Psychology. Michael’s aggression should also improve and/or dissolve altogether if he does not take cocaine in any form (Myers 2005).

Although Derrick (from the case study presenting similar symptoms) was only thirteen-years-old, indications are that the hormonal changes at the beginning and the end of adolescent development are comparable, and- when combined with stress or trauma- they can trigger the further development of latent behavioral, mood, or other disorders involving mental health (Myers 2005).

Case Study 2

Ms. B was sexually abused for five years by her stepfather and ran away from home. She is a single mother of two who repeatedly forms romantic attachments to abusive male partners, thus perpetuating her delusions of gender roles and her feelings of disempowerment. Ms. B’s case study bears a striking resemblance to that of The Noonday Demon’s case study of Lolly Washington. Lolly was a single mother of her rapist’s baby who had been sexually abused by two separate female acquaintances and ran away from her home at a young age. She was later pressured by her family to marry another physically and verbally abusive man; he pressured her soon after to have children and physically abused them also. Lolly was depressed by her perceived inability to care for the children on her own (Solomon 2001).

The main difference is that Lolly sought help from the local family clinic before she attempted suicide. Lolly herself expressed doubt that she would still be alive if she had not walked into the clinic on that day. Even though Lolly sought help, she still resisted (Solomon 2001). In the same way, involuntary hospital admission should provide a strong influence to combat Ms. B’s resistance to treatment. Although the general view is that you can only help the wiling, suicide attempts are inherently either cries for attention or a genuine desire to either avoid pain (as in Farmer Bill’s case) or to end life itself. In either case, immediate action is necessary to Ms. B’s recovery. We will examine her case through the three different perspectives, refer to similar cases, and then suggest an inclusive approach to her treatment.

Medical

From a biological or medical stance, there is nothing bodily wrong with Ms. B. She is healthy and presumably not suffering from postpartum psychosis. However, along with middle-class status, such as that of Ms. B and Lolly, is essentially linked to constant stress that ranges from mild to severe given the financial and physical state of the adult members of the family.

It is unclear at this point if Ms. B’s diagnosis will include chemical dependency. The background states that the patient was intoxicated when she attempted the overdose- but makes no mention of the frequency or extent of her alcohol consumption. Regardless, the added depressant of alcohol increases her high risk of suicide even further. According to Bloch (2002), “Alcoholism is a factor in about 30 percent of all completed suicides” (359). The patient’s history denotes a gradual progression from minor, superficial cutting to serious suicide attempts. All chemical dependency and/or substance abuse should stop immediately for the patient’s well-being. Ms. B made a serious suicide attempt while intoxicated this time, and the relaxation of this self-medication is caused by the sympathetic nervous system’s slowing of activity. This cognitive deceleration controls judgment and inhibitions and also making the drinker more aggressive and prone to atypical sexual or other self- exploitative acts (Myers 2005).

Psychological

Constant psychological stress will eventually manifest itself as a vulnerability to illness- medical and mental. With lower economic status come specific challenges of expression of the problem itself; they often express incredulity that there are varying levels of mental illness, that depression is not the equivalent of craziness. Furthermore, they are often oblivious of the deep-rooted feelings of guilt, inadequacy, and failure which fuel depressive states of most socioeconomically-disadvantaged people.

Minimal alcohol consumption is not detrimental. However, it is a logical assumption that Ms. B’s stressors created a “perfect storm” which intensified her feelings of worthlessness and her desire to drink. According to Douglas Bloch (2002),

“If you’re depressed, you’re more likely to use alcohol and other drugs to medicate your feelings. And if you use alcohol and drugs, you are more likely to develop depression. Thus, alcohol and drug abuse can be both the cause and the result of clinical depression” (394).

No mention has been made of the father(s) of her two children. It is possible that she has sought out familiarity in her relationships in the form of verbal, physical, and/or sexual abuse from her male partners. This is a topic for psychotherapy, which should commence immediately and utilize the psychodynamic approach to focus on resolving her repressed experiences with her sexually-abusive stepfather.

Dream analysis might be helpful, especially where vivid symbolism of the repressed events is clear. If the patient can come to neutral, detached conclusions about the meaning of the symbolism, then she can further relate this knowledge to the relationships of her past, present, and future (Bloch 2002). Zuess (1998) lauds the potential of creativity to unlock the psychological healing powers of the mind. On page 66 of The Wisdom of Depression, he states that:

“Once the flow of creative energy from the subconscious body- mind has been allowed to initiate the depressed response, the person remains in an unstable, disoriented, and vulnerable state until a new inners synthesis is  formed”.

The success of psychotherapy can aid, but as the seriousness of the impediments to normal psychological functions increase, the likelihood of reaching the “new inner synthesis” decreases. Furthermore, the constant stresses of single parenthood may place a significant impediment to the treatment of the patient, and the cost to both the patient and her children is greater if the repressed memories are brought to the surface and not efficiently resolved (Zuess 1998).

If a medical cause were to be found which can explain Ms. B’s symptoms, psychotherapy should still be recommended, because “to say that a problem is biologically based is not to say that it has no unconscious significance” (Ratey & Johnson 1997, 17). As support for this claim, Shadow Syndromes presents the case study of a mother with an anxiety disorder who has a mutually possessive relationship with her young son. He does not want to go to school, and she does not want him to go either.  They both suffer from mild forms of mood disorder which gradually become part of their overall character. Their solitude and proximity to each other only serves to further their anxiety in unfamiliar situations. Depressive habits often become depressive characteristics (Ratey & Johnson 1997).

Sociological

Interestingly, Lolly’s recovery was mainly achieved by continued talking therapy. Her husband and drug-addicted sister attempted to persuade her to leave therapy when her dependence upon their approval lessened. Personal perseverance (one of the strengths of the VIA, as mentioned earlier) gave Lolly the positivity to mentally combat her depression. Her success was not achieved without the support of her peers and illustrates the importance of the support system to the continued progress of the patient. Case studies concerning women, like Lolly, who have gone through similar circumstances could provide a sense of inspiration for the patient, Ms. B, to draw from. (There is more on the strength of relationships later.)

Case Study 3

Simon is an Australian male in his mid-30’s who is of Aboriginal descent. In Australia there is a distinct social differentiation between the Aboriginal and other indigenous peoples and the people who could be termed newcomers. By the same token, the “newcomers” are often disinclined to accommodate the differences of socioeconomic status that are a part of the heritage of the Aboriginal peoples. As such, there is a distrust which permeates all levels of society and adversely affects the equal treatment of patients.

Firstly, Aboriginal patients regularly experience several cultural disadvantages: rampant unemployment, poorer housing, less education, and higher rates of imprisonment. Today’s indigenous Australian children are the offspring of the so-called Stolen Generation. In 1981, fifty-seven percent of the children in the welfare system were of Aboriginal descent. In the end, according to ALSWA (1995), the emotional and social trauma of these actions far outweighed any potential advantage to the children- many of whom suffered from low self-esteem, anger, depression, increased suicide risk, personality disorders, posttraumatic stress disorder, and the inability to form lasting, deep relationships with their romantic partner(s), children, and family (as cited by Vicary & Westman 2004).

Social history aside, the disagreements of the Aboriginal and “newcomer” societies are fundamentally and philosophically different in other aspects as well. While the modern Western view is largely dependent on synthetic health solutions, the indigenous citizens of Australia typically prefer “the incorporation of mind, body, spirituality, environmental and spiritual constructs… of socio-historical-political factors implicated in the development of disorder amongst Indigenous groups” (Vicary & Westman 2004, 131). Patient trust and perception can form a significant portion of their ability to heal themselves, as we have seen in numerous tests which involve the double-blind administration of placebos.

Indigent patients typically do not acknowledge mental ailments as real; that is, they seek help for physical manifestations of psychological conflict. Such physical manifestations often include (but are not limited to) sleeplessness, emotional distancing, sickness, fear, and exhaustion (Solomon 2001).

The Dimensional Assessment for Personal Pathology- Basic Questionnaire (DAPP-BQ), which was mentioned in our discussion of Michael’s psychotic case, is one excellent source. Other credible sources for screening are the Schizotypal Personality Questionnaire (SPQ), the Chapman Psychosis Proneness Scales (CPPS), the Chapman Infrequency Scale (CIS), and the L and K scales from the Minnesota Multiphasic Personality Inventory– 2 (MMPI-2). Patients scoring in the top ten percentile for the SPQ are likely to be schizotypal. High scores on the CPPS are also reliable indicators for various, severe schizophrenic disorders, particularly with reference to the subscales of Magical Ideation and Perceptual Aberration (Tackett et al. 2009).

The bio-psycho-social perspective emphasizes the interrelationship of brain biochemical, psychological, and social factors, and the development of schizophrenia has been linked to different medical, psychological, and social predictors. Examinations of the remains of deceased schizophrenic patients have shown that their brains typically contain six times the normal number of dopamine receptors, creating an overdose of positivity which produces hallucinations and paranoia. In schizophrenic patients, the thalamus is smaller (and thus less able to focus and persevere), and brain activity in the frontal lobes is lower. Cerebral shrinkage has often been linked to the disorder and will sometimes precede the actual development of the condition and its symptoms. Other medical correlations have been found in genetics, prenatal development, and birth (Myers 2005).

The details of the psychological and social factors are mostly guesswork at this point. Psychological trauma and social inadequacy are common triggers of schizophrenic presentation, but are not present in all cases. However, certain overriding truths have been found. In Simon’s case, over the course of two years his paranoia and withdrawal from society have rapidly increased as he prepared to enter college after taking a very important college entrance exam. As Exploring Psychology stated, “Social withdrawal does often occur in adolescence or early adulthood, coinciding with the stresses of having to become independent, assert oneself, and achieve social success and intimacy” (Myers 2005, 136).

If one thing has been proven an irrevocable fact, it is that chronic or process schizophrenia which presents itself in a gradual arc of additional symptoms, recovery is not likely, because the condition shows minimal response to medication. It is likely that the irrationality, incoherence, and paranoia of his progressing schizophrenia are likely to continue virtually unchecked by medical approaches alone (Myers 2005).

Women in Mental Health System

The debate over the possibilities and limitations of women has not been limited to the philosophical realm; the mental health system has recognized that the cocktail of unique hormones present within the female body of any age presents unique differences from the traditional therapies and facts that solicited only male subjects. The issue of how exactly to treat women and how exactly they are treated are two interrelated sociological concerns which involve a great more than meets the eye: the psychological debate of nature versus nurture, the traditional oppression, general social disempowerment and prejudice (such as the gender wage gap), and the perpetual search for a deeper meaning (Bentley, K. 2005).

As if the stresses of menstruation, pregnancy, and childbirth are not enough, women who find themselves in the mental health care system quickly discover that the unique capacity to give birth comes with a load of bells and whistles which interfere with the normal functioning of mental processes, hormonal shifts, and normally-helpful prescriptions. Furthermore, a mental concept of normalcy is often skewed by the occurrence of the regular intervals of premenstrual syndromes.  Society and psychiatry both view women as susceptible to trifling illnesses, as if menstruation is “a bug” one catches (Raskin 1997). In one of the first major gender-specific studies of the 1970’s, the Broverman study examined what comprised a healthy adult, healthy male, or healthy female. The descriptors that were chosen as befitting a healthy adult were the same as those of a healthy male. By contrast, the healthy female was ascribed a state of being “dependent, subjective, passive, and gentle” (as cited by Bentley, K. 2005, 56).

Contrary to the popular depictions of women as accepting, submissive, and weak, the psychiatric ward for the chronic inpatients often revolves around one central or alpha female. She typically displays masculine stereotypical qualities, such as strength, violence, and a propensity for confrontational interpersonal relationships. Psychiatric patients and staff alike are drawn to the alpha female as the epicenter of the sociological consciousness in the ward. In their book Shadow Syndromes: The Mild Forms of Major Mental Disorders that Sabotage us, the co-authors, Doctors Ratey and Johnson, compare the adult alpha female of a psychiatric wing to the “problem child” of a family unit, explaining that in family systems theory the problem child was thought to be a symptom of the metaphorical skeletons in the family’s closet. Ratey and Johnson portray this role as one of sacrifice: saying that the problem child is “the person in the family who agrees to embody all of the problems the rest of the family wishes to deny” (Ratey and Johnson 1997, 58). Even in their alpha female informational challenge of the sociological status quo, Ratey and Johnson depict the stronger set of women as sacrificial lambs.

The primary biological function of the female body is to produce offspring; sacrifice is essential to the femininity of women’s bodies. With this femininity there often comes an instinctual bond to children. The decreased sleep and additional stresses of newborn children puts a large amount of stress on women which can trigger a reaction with the normal cognition of the brain. New mothers are barraged with procedures for the baby and procedures for self-care, as well as ominous warnings about Shaken Baby Syndrome, Sudden Infant Death Syndrome, and accidents related to the infant’s sleeping arrangements. Whether or not they receive additional support from other people, outside help does little to combat the stresses and hormonal shifts which are a part of female status until menopause has run its course (Raskin 1997).

Although there were earlier notable works, in the years 1910-1920, there was a great outpouring of literature which criticized the view that domestic life was a woman’s only path to happiness; during those years “Trifles” and “The Yellow Wallpaper” were published among other short stories. In the early feminist literature the strength in independence and in female social companionship was implied. Still, it was not until the previously-mentioned Broverman study that the medical, psychological, and sociological communities truly confronted this changing of the guard. Gilligan was among the most prominent ethicists and psychologists to assert that- while different from those of men- the decisions, aims, and cares of women were no less important to their overall well-being and that the early feminist writers had been correct about the importance of same-sex connections to a sense of strength (Bentley, K. 2005).

References

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