Homosexuality used to be a psych disorder in DSM 4. Drunk driving is socially acceptable 1. Implications for diagnosis using medical model 1. Unreliability of diagnosis is common - Should always get a second opinion 1. No consensus on treatment for many illnesses 2. Blocked arteries 3. Two major treatments doctors disagree on 4. Surgery-Coronary artery bypass graft surgery 2. Special focus: how good is diagnosis of mental illness? 1. How do hospitals decide who is "really insane" and "really sane"? 2. - hard to decide if someone is really mentally ill 3. Not always just in the mind. May have to do with the social situations 4. Researcher did a study to answer this question 1. Being Sane in Insane Places: Study 1 1. Could hospitals distinguish "pseudo-patients" from "real" patients 2. 8 sane people gained admission to 12 different hospitals; these people faked mental illness. Stayed an average of 19 days. A range of 52 days. Complained of hearing voices in the past; symptoms were vague. Lied about identity. None of their histories were pathological. Behaved normally 3. Results
33 4. They were diagnosed with schizophrenia in remission 5. They got all of the usual treatment and drugs. Didn’t really take the drugs. 6. None of the staff members suspected they were faking. But the other patients did cause they spent the most time with them Why did this happen?-social expectation - Doctors have a bias for detecting illness, not wellness They expected that people who check themselves in are actually ill. Not very fun. - Being admitted brands you as a mental patient-stigma - VP eagleton-diagnosis 1. Being Sane in Insane Places: Study 2 1. Hospitals were angry, felt tricked 2. Researcher gave them another chance, challenged them to distinguish pseudo- patients from real patients for the next 3 months 3. Results Interpreted many as pseudopatients, when no pseudopatients were actually sent. Because of their new social expectation 1. Other major finding 1. Once a person was diagnosed mentally ill, the label influenced the interpretation of all behavior, even normal behavior • -taking notes were interpreted as part of their diagnosis-memory loss • Conclusions • Doc‘s diagnoses were reasonable given their existing knowledge at the time • BUT a diagnostic process that results in such massive errors is not very reliable • Docs have a bias toward active treatment Lecture 6: Epidemiology I. Diagnostic and Statistical Manual of the American Psychiatric Association, version 5 -describes the symptoms of mental illness A. DSM II - "neuroses", "Oedipal conflicts”- disorders not behaviors, they are conflicts that affect the brain. B. Oedipus complex-boys lust after mother hates father. Starts to identify like dad to get the girl. Develops masculine identity C. Electra complex-girl lusts after father. Hates mom. begins to identify like her D. DSM III - behavioral description of mental illness- was focused on behavior E. DSM IV and V - refined and improved II. Post Traumatic Stress Disorder (PTSD) A. Diagnosis- highest stress situations. Common in soldiers during war time. Stimulus.
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