Mental ill health has not always been identified in our society; it is only in the 20th century that illness’ like schizophrenia and depression have been recognised. Before this time, anyone presenting behaviour that did not fit in with the social norm was seen to be ‘possessed’ by an evil spirit. It has been suggested that the accused in the Salem witch trials may have been mentally ill people, a theory which would make sense.

The idea that people with psychological problems were possessed was very much a belief held by most of society however, the idea that these abnormalities came from our biology was not revolutionary. Hippocrates believed that ‘psychopathology resulted from bodily disturbances’ (Hippocrates, n.d., cited in Joseph. S, 2001, 33) He believed that the body consisted of 4 chemicals named the 4 humours, (black bile, yellow bile, blood and phlegm) if these 4 chemicals became unbalanced then we became ill either physically or mentally and the treatment would be to try and balance the chemicals by- for example- blood letting.

These ideas were the beginnings of what is now known as the medical model in mental health. The medical model now assumes that biology and neurochemistry are the causes of mental illness and ‘A person’s behaviour and experience may change if there are chemical changes in the brain.’ (Joseph. S, 2001, 31) The medical model is widely used today in psychiatry and aids scientific research into the causes of many psychiatric problems.

Assignment: Mental ill Health

Assignment: Mental ill Health

As a result of this research scientist are able to develop treatment for psychiatric disorders and improve the quality of life for many people. However there are many criticisms of the medical model and on of the main critic is Thomas Szasz.

In oppose to the medical model Thomas Szasz developed his own theory for explaining psychological problems. His theory was based on the idea that mental illness did not exist and the abnormal behaviour presenting in ‘mentally ill’ people were just ways of coping with the stress of their world and that the ‘concept of a distinctively normal well-functioning personality is rooted within psychosocial and ethical criteria. (Szasz. T, 1974, 209) In other words people with psychological problems can’t interact properly with society and its values and the abnormal behaviour they produce is a way of coping with life.

Szasz is in oppose to almost every aspect of the medical model including the way in which classification systems are used to diagnose people with certain disorders. Smail who takes on board a similar view to that of Szasz criticises ‘Psychiatry’s obsession with cataloguing the phenomena of distress into diagnostic syndromes of illness is rendered ultimately futile precisely because the supposed victims of such illness are not carriers of clear- cut cultures of disease, but in essence ordinary beings struggling to cope in a disordered world’ (Smail, 1996a, pp. 49-50 cited in Joseph. S, 2001, 150)

The medical model would argue that Kraeplin’s (1856-1926) discovery that certain symptoms occurred together suggests that types of disorder do exist., and that classification systems such as the DSM IV and ICD 10 have useful in the diagnosis and treatment of many disorders since 1952. One of these illnesses is depression. The DSM IV states the criteria for diagnosing depression as:
After the diagnosis of an illness such as depression, a treatment plan is needed, however before treatment can be administered it is essential that the right treatment is given. In order to give the right treatment, the cause of the disorder must be identified and this is why there is much research into the mental illness of depression.

In the 1960’s Joseph J. Schildkraut suggested that a deficiency of norepinephrine caused depression however a deficiency of this chemical does not affect mood in everyone and it was discovered at a later time that the cause of depression also involves the depletion of serotonin at the synapse. A new suggestion is that dopamine plays the final part in the role of depression however dopamine has only been found to be a cause in a small sample of sufferers. (Schimelpfening, 2004) Another suggestion comes from (Duman et al., 1997 cited in Satcher, D et al, 1999) who say that depression may derive from reductions in neurotrophic factors needed for certain neurons to survive.

Assignment: Mental ill Health

Assignment: Mental ill Health

These causes are all biological and are what the medical model assumes causes depression.

In contrast Thomas Szasz believes that most psychological disorders are just alterations or an exaggeration of normal behaviour his view on depression is that it is one of many ‘manifestations of disturbances in the social structure’ (Joseph. S, 2001, 142) Szasz suggests that “The mental illness of depression is a dramatisation of the proposition ‘I am unhappy’” (Szasz. T, 1961/1972 p.202) Schildkraut and Duman provide evidence for the fact that there is a biological basis for depression.

The view taken by Thomas Szasz also has some research to back up theory. Brown and Harris (1978) interviewed women living in London and found that there were four social factors contributing to depression: Women from lower social classes are more vulnerable to depression than middle class women, absence of a confiding relationship, 3+ children at home under 14 yrs, Loss of own mother at age 11 or under (Brown and Harris, 1978, cited in Harry Brignull, 2000) The fact that social class appears in the above list, indicates that not only our day to day experiences have an influence, but also as Szasz suggested, society as a whole.

After the process of diagnosis, it is only logical that treatment will follow, and both models possess very different ideas on treatment. Persons suffering from depression who are perceived to be neglected themselves can be sectioned under the Mental Health Act (SEE APPENDIX 2 FOR CRITERIA) this is supported by the medical model. However Thomas Szasz believes that mental illness is something that a person does and that a sufferer is responsible for there own actions and should have a right to freedom. If the person decides they do not want to seek help then they should be left to get on with their lives and should they harm anyone, be punished in the same way as a person of stable mind.

Should they choose to be treated, Szasz believes that self knowledge is the key to treatment, and that a psychiatrist’s job ought to be to help the person realise what they are doing. The client should define when the therapeutic relationship should end. Ultimately this would happen when the person believes their problem has been solved and they are happy with the changes made to their lives.

It could be said that cognitive behavioural therapy may be similar to Szasz’s idea of how someone should be treated. In cognitive behavioural therapy the therapists job is to help the client realise how absurd their thoughts actually are and then help them to change their behaviour. However Szasz, depending on how the therapist goes about helping, may dispute the fact that the therapist is to help change the client’s behaviour as his view is that no coercion should be involved. (ed. Cutting. P, Hardy. S & Thomas. B, 2002, 25) The treatment he suggests is the same for every disorder including depression, as Szasz does not believe in the classification of mental illness

This view of treatment heavily contrasts with the medical model’s view of treatment (SEE APPENDIX 3 FOR A CAREPLAN FOR DEPRESSION) There are three types of treatment suggested for depression; drug therapy, electroconvulsive therapy and psychosurgery. Drug therapy is the most widely used it is used on moderate to mild depression and the patient is prescribed either monamine oxidase inhibitors, tricyclic antidepressants or selective serotonin reuptake inhibitors. The job of these types of drug is to influence activity at the synapses in the brain and make the neuron more likely to fire and release neurotransmitters like serotonin however the MOI’s and the TCA’s also influence other neurotransmitters and side effects are a problem.

Another problem with TCA’s are that they cannot be given to: people with ideas of suicide, the elderly and people with heart disease or narrow glaucoma. SSRI’s are the most effective of the antidepressants and the side effects are kept to a minimum as they only affect the neurotransmitters involved in depression. However SSRI’s do not work for all people suffering depression. Also all of the above drugs take up to two weeks to begin to work, if a patient is suicidal or all possible drug therapy has been exhausted then treatment would move on to electro convulsive therapy. (Moore B, Moore P & Wilkinson G, 1999 59-69)

ECT is where the brain (either one or both sides) is stimulated by an electric pulse causing a shock, it has immediate affects and the reason for this is unknown. However when ECT was first introduced it did cause damage to many people and now everyone having ECT must have a muscle relaxant to prevent and muscular damage and it has been shown to cause short term memory loss (ed. Brewin C R, 1997, 134-136)

A new treatment similar to ECT has just been introduced Transcranial Magnetic Stimulation, this is where a hand held electromagnetic coil is placed at specific parts of the head causing magnetic stimulation without inducing a seizure like ECT. It has been tested successfully in treating severe depression however it is still being researched and developed and like ECT is not free of side effects. (Citrome L, 1999) The final treatment used is that of psychosurgery however it is very rarely used as it involves a serious operation in which parts of the brain concerned with depression are altered. ECT, TMS and psychosurgery can all be described as inhumane and unnecessary however they have been proved successful as a last resort.

In summary the medical model assumes ‘psychopathology is the result of physical imbalances, and that psychological problems represent some underlying cause’ (Joseph S, 2001, 56) Biological treatments for depression have been proved a success however they do not tackle the underlying cause of the depression and we cannot take on board the deterministic view that ‘anatomy is destiny’ (Joseph S, 2001, 57) On the otherhand Thomas Szasz believes that the society we live in, the people around us and all their morals and beliefs are what shape personality and that psychiatrists deal with ‘personal, social and ethical problems in living’ (Szasz T, 1974, 262) However his views about treatment and a persons right to freedom of choice are not without flaw as many mentally ill people are danger to themselves and some a danger to others and we cannot ignore the fact that biological research has shown the links between neurotransmitters and depression.

To conclude it is felt that a more eclectic approach is needed for the diagnosis treatment and care of people with depression and the bio-psychosocial-spiritual model used in mental health practice today, is indeed the best option. It gives people a chance to be treated biologically, deal with the underlying cause of depression and keeps in mind their morals, beliefs and to some extent allows freedom of choice.

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

 

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.
Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.
APA Format and Writing Quality

Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.
Use of Direct Quotes

I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.
LopesWrite Policy

For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.
Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.
Communication

Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.