BRIEF CONTENTS Part 1 Concepts 1 1 From Disorder to Experience 3 Part 2 Forms of Distress 191

PROOF v

BRIEF CONTENTS

Part 1 Concepts

1

1

From Disorder to Experience

3

2

History

19

3

Culture

55

4

Biology

75

5

Diagnosis and Formulation

101

6

Causal Influences

118

7

Service Users and Survivors

139

8

Interventions

158

Part 2 Forms of Distress 9

191

Sadness and Worry

193

10

Sexuality and Gender

219

11

Madness

249

12

Distressing Bodies and Eating

283

13

Disordered Personalities?

308

PROOF

PART

1

CONCEPTS 1

From disorder to experience

3

2

History

19

3

Culture

55

4

Biology

75

5

Diagnosis and formulation

101

6

Causal influences

118

7

Service users and survivors

139

8

Interventions

158

PROOF

PROOF

CHAPTER

1

FROM DISORDER TO EXPERIENCE Bess’s story Bess is a 19 year old African Caribbean woman. She was referred to clinical psychology services after being admitted to a psychiatric hospital, because her medication had not lessened the voices she heard nor altered the unusual beliefs she held. Before her admission she had been living with her mother, brothers and sisters in a large industrial town. Bess is the oldest of four children. Since the age of 9 she had been largely responsible for taking care of her siblings, whilst her mother worked long hours to support the family. Nevertheless, Bess did well at school, although she sometimes experienced racist bullying. Often, her father drank heavily and was physically and verbally abusive – towards his wife, but occasionally towards Bess. Then, when Bess was 12, her father came home drunk and pressured her for sex. He threatened to hurt her brothers and sisters if she didn’t comply, and Bess reluctantly agreed. She hated the sexual contact, but relished the affection she received from him. After two years of this sexual abuse, Bess’s father left to begin a new relationship. Bess was devastated. She deeply resented her mother’s anguish at losing him, and their relationship deteriorated. After her father left, Bess was confused. She resented the way he had treated her, and wondered why he didn’t contact her. She continued to work hard at school and did extremely well in her exams. When she was 16, Bess noticed that although the bullying had mostly stopped she still felt like an outsider. She began finding it difficult to concentrate, and became preoccupied with the belief that one day she would meet someone who would take her away to a new life. Around this time she had a new boyfriend who wanted to turn their relationship into a sexual one, but Bess refused. When she eventually explained to him what had happened with her father, he ended the relationship. Bess felt that everyone she loved would abandon her. She was deeply shamed by what her father had done to her, judging it to be her own fault. Bess began to spend more time alone, praying. She believed she was receiving messages from God, and began listening to loud music to block out the voices she increasingly heard. She drank large quantities of alcohol, and slowly became convinced she had a personal relationship – with sexual overtones – with one of the pop stars she listened to. This made her feel ashamed, but the pop star told her that one day he would take her to heaven where she would find peace. She heard his voice often, especially when she felt lonely and miserable. Increasingly, though, she also heard her father’s voice, commenting critically on her actions and morals. Eventually, Bess told her mother about these experiences. Her mother became angry and contacted a doctor, who referred Bess to psychiatric services. This led to a violent confrontation between Bess and her mother; Bess was then forcibly admitted to hospital.

PROOF CONCEPTS

4

Learning outcomes

What is distinctive about this book?

After you have read this chapter, you will be able to:

The approach taken by this book is somewhat different from those of other books in this area. One very obvious difference is that, unlike many others, we do not use the term ‘abnormal psychology’ to describe what our book is about (later, we offer a detailed explanation for this). But in fact this book has several distinctive features, so it will be useful to emphasize some of them here. First, in this book we take a consistently psychological approach to mental health. Usually, psychology books on mental health are already pre-structured in terms of psychiatric diagnostic manuals such as the Diagnostic and Statistical Manual of the American Psychiatric Association – the DSM (see Box 1.1). Chapter titles are usually based upon diagnostic labels, and explanations are typically directed at ideas of mental illness that have already been formulated within psychiatry or medicine. Instead, in this book we offer a perspective that is more suitable for students from non-medical backgrounds who might want to train as (for example) clinical psychologists, social workers or CBT practitioners. We have already suggested that we will do this by starting with experience rather than notions of disorder, and there is more discussion of what this means later in the chapter. Second, most other books of this kind pay relatively little attention to recent psychological research – much of it from the UK – which has focused on particular kinds of experience, such as ‘hearing voices’, rather than diagnostic categories, such as schizophrenia. This research has shown that it is possible to make significant progress in understanding and responding to people’s difficulties without having to endorse psychiatric diagnoses. Of course, this does not mean that we don’t consider psychiatric diagnoses in this book – just that we don’t treat them as necessarily explaining people’s mental health difficulties. Third, many other textbooks claim that dimensional models are less clinically useful than psychiatric diagnoses. Dimensional models do not presume a sharp dividing line between mental health and mental illness, and recognize that all of us, sometimes, have distressing and unusual experiences in our lives. They are usually contrasted with categorical models, where mental illness is clearly distinguished from mental health and is thought to fall into specific, separate categories: psychiatric diagnosis exemplifies this approach. But in the UK, at least, the vast majority of clinical psychologists use dimensional models in their clinical practice, so this book frequently takes a dimensional approach. Fourth, most other mental health textbooks contain a series of chapters, each focused on a particular psychiatric diagnosis. But although they present extensive information about each diagnosis, they rarely try to explain the associations and connections between them. Typically, textbooks claim to promote a biopsychosocial model of mental health – an approach within which biological, psychological and social influences are all considered or modelled together. But because they don’t usually contain very much discussion of the links between ‘bio’, ‘psycho’ and ‘social’, the model actually tends to remain relatively obscure. Moreover, because these textbooks are invariably structured around psychiatric diagnoses, they also tend to be reductive – in other words, they tend to treat biological influences as foundational, or as more important than others. By contrast, in this book we try to consider the

Explain why terminology is especially important in relation to mental health Explain what is meant in this book by ‘distress’ Describe some of the problems associated with everyday definitions of normality Explain the problem of thresholds in relation to psychiatric diagnosis Define key terms, including: service user, distress, madness, psychosis, neurosis, hallucination and delusion

1 2 3 4 5

Introduction This book is about people like Bess. People distressed by life, their relationships, and their position in the social world. It is clear from Bess’s story that her distress is far from straightforward. Do her difficulties arise from her unstable relationships, from the way she thinks about the world, or the ways in which she has learned to cope? Whilst there are no easy answers to these questions, we hope that this book will provide some ways of thinking psychologically about the kinds of issues facing Bess and others who have had experiences like hers. In this chapter, we first of all explain what is distinctive about this book and why we approached this topic in the way that we did. We discuss the importance of terminology and describe why language is important: both because it provides the concepts we use when thinking, and because of its links to stigma and discrimination. We explain how in this book we will focus on distress (which for now you can simply read as meaning ‘mental illness’ or ‘psychopathology’), and how we will treat distress as a form of experience – something that happens within the life and the subjective awareness of a person – rather than as a form of illness. Then we give some of the reasons why we decided not to call this a book about ‘abnormal psychology’. Approaches to mental health and illness that do not endorse simple notions of abnormality are often described as anti-psychiatry: this is the collective term for a set of disparate work, published mostly in the 1960s, which rejected the view that mental health problems are illnesses or diseases. We explain why we do not call our approach anti-psychiatry; consider the issues raised by a focus on distress as something that is perhaps ‘in the mind’; and briefly describe some of the ways in which mental health professionals have modelled and conceptualized their field. These discussions are followed by a short overview of the rest of the book, and a guide explaining how to get the most out of reading it.

Guiding questions As you read this chapter, you should bear in mind these two questions: Why might we question the notion of abnormal psychology? 2 What are the implications of rejecting psychiatric diagnoses in mental health? 1

PROOF FROM DISORDER TO EXPERIENCE 5

links between ‘bio’, ‘psycho’ and ‘social’ in a more nuanced and conceptually sophisticated manner. Finally, in these textbooks, the discussion of critics of psychiatry, and of the controversies associated with its diagnoses and assumptions, almost always seems to stop at the end of the 1960s. If one were to judge by such books, one might almost believe that all of the problems that these critics had raised were now solved. But this is not the case, and in the five decades since the 1960s there have been many more critiques of, and alternatives to, psychiatry. These critiques and alternatives have come from clinical psychologists and from those who use mental health services, as well as from psychiatrists themselves. In recognition of this, our book is also distinctive because it includes a chapter written entirely by mental health service users. In writing this book we have therefore made a number of assumptions: for example, that psychiatric diagnosis does not necessarily provide the best way to approach mental health problems; that a more sophisticated psychological account of mental health problems will be useful; that mental health service users have valuable things to tell us about mental health difficulties and interventions. All authors have an assumptive framework – a worldview within which certain things are implicit and simply taken for granted. These assumptive frameworks are rarely made explicit, but we thought it would be helpful for you to have a sense of our starting points and assumptions so that you can take them into account as you read the book. Importantly, we have not written this book as a polemic and we accept that you may agree or disagree with some of our judgements. Throughout the book we will be presenting evidence for and against different ways of conceptualizing

1.1

BOX What is the DSM? ‘The DSM’ is The Diagnostic and Statistical Manual of the American Psychiatric Association. It contains the diagnostic criteria that American psychiatrists use in their practice. In Europe and the UK, psychiatrists most often favour the slightly different psychiatric diagnostic criteria set out in The International Classification of Diseases (ICD), produced by the World Health Organization. However, although they may use these criteria in their practice, for research purposes UK and European psychiatrists also tend to use the DSM. Both the ICD and the DSM have been subject to frequent revisions. The ICD is currently on version 10, whilst the current DSM is known as DSM-IV-TR: version IV, text revision. As we went to press, both DSM-5 (the APA seem to have changed their numbering system) and ICD 11 were expected shortly. At least in its current version, the DSM claims to be purely descriptive and

mental health and illness, so that you can come to your own conclusions. Of course, in attempting to write about mental health in a different way we had to think carefully about the language we used. There are many reasons for this, but perhaps the most important is that language contains concepts that structure our thinking. If we use concepts that are inconsistent or unhelpful, our thinking can become muddled. This meant that we needed to ensure that our approach was internally consistent, so it is to the issue of terminology that we turn next.

Terminology One of the first challenges in learning about the psychology of mental health is the wide variety of terms and concepts used. Like the language used in relation to any other real-world phenomenon, none of these terms is neutral or value-free. All of them seem to imply something about the nature or the causes of the phenomena they describe, and all of them are more closely associated with certain disciplines and perspectives than with others. The term mental illness, for example, clearly suggests that our talk will be of matters related to health and sickness, that it will have a medical character but that it will also take a mentalistic or psychological focus. Another widely used term, psychopathology, makes exactly the same assumption because it adds the concept of disease – pathology – to the prefix ‘psycho-‘, which is short for ‘psychological’. In both cases, then, the terminology already assumes that our perspective upon these phenomena should be a fundamentally

a-theoretical, instead of depending upon concepts derived from theories. This means that it does not use earlier concepts such as neurosis: a collective term for forms of distress that involve exaggerations of everyday responses (e.g. excessive worrying) but do not involve distorted perceptions or unusual beliefs. Whereas the concept of neurosis was originally derived from psychoanalytic theory, the DSM purports to be no more than a set of descriptions of the disorders frequently observed by clinicians. These disorders are proposed by panels of experts, and are subject to a consultation process and approval by a central committee before they can be included in the manual. Despite this, critics argue that the DSM is far from value-free and neutral. They suggest that in practice the DSM furthers the interests, not just of psychiatry, but also of the pharmaceutical and insurance industries (because, under America’s insurance-based healthcare system, a diagnosis is needed in order to reclaim the cost of treatments such as medication).

Another concern frequently raised by critics is that the DSM has promoted the medicalization of everyday life: in other words, it encourages us to see everyday difficulties and stresses (for example, shyness) as ‘symptoms’ of ‘illness’ that then require ‘treatment’. Certainly, the number of separate diagnoses within each version of the DSM has tended to increase with each revision, as the table shows. However, advocates of diagnosis argue that the system is simply becoming more accurate and refined over time, and that the changing numbers reflect this process of development. TITLE

YEAR

DIAGNOSES

DSM

1952

106

DSM-II

1968

182

DSM-III

1980

265

DSM-III-R

1987

292

DSM-IV

1994

297

DSM-IV-TR

2000

297

Chapter 5 contains a lengthy discussion of psychiatric diagnosis and the issues that are frequently associated with it.

PROOF 6

CONCEPTS

How we see or represent the world depends on how we choose to frame it, as well as upon what there is in the world for us to see

medical one, and that at its most basic level our concern is with people who are diseased or sick. We think that this assumption is incorrect. In our view, when people are given diagnoses such as schizophrenia or depression it is neither accurate nor helpful to think of them as being medically ill or diseased. So in this book we will use the terms ‘psychopathology’ and ‘mental illness’ very infrequently, and even then only when they are already being used by the people whose work we are drawing upon. In their place, we will use the term distress. When we use this term, we use it to refer to just the same kinds of phenomena that textbooks of this kind usually call mental illness or psychopathology. We use distress to mean all of the different kinds of difficult or unusual experiences associated with the hundreds of psychiatric diagnoses currently employed. Distress is our term for the core subject matter of this book: the experiences associated with diagnostic categories such as schizophrenia and depression, and with the work of professions such as clinical psychology, psychiatry, social work and nursing. However, to reduce repetitive language, we will occasionally draw on other phrases like ‘mental health problem’. This terminology is also open to challenge, because by locating these experiences in relation to health it also implies a link to illness. However, it is more ambiguous than ‘mental illness’, carries less conceptual baggage, and is easily understood because it is widely used. Similarly, we will sometimes use the term madness to collectively describe experiences associated with the more

severe forms of distress. These include experiences such as hearing voices, which is an example of a hallucination: a general term for the perception of a stimulus that is not present. They also include advocating the unusual beliefs that clinicians call delusions: beliefs that can be shown to be either impossible or false, but which are sometimes proclaimed strongly by service users. These experiences are primarily associated with psychiatric diagnoses such as schizophrenia and bipolar disorder, and are sometimes collectively referred to as psychosis. There has been a recent debate in the UK about terms like psychosis and schizophrenia, and a ‘Campaign against the Schizophrenia Label’, which has received significant media attention. As with the other terms we favour in this book, we have used madness rather than psychosis because it mostly avoids the many connotations of illness or disease that accompany the alternatives. You will probably be familiar with discussions about terminology from other areas of your studies. Because language supplies the concepts that structure our thinking and debating – sometimes very subtly, in ways we don’t necessarily realize – it is vital to ensure that we are using appropriate terms. However, it’s also important to realize that, in relation to distress, these discussions are often particularly contentious. Because distress touches the lives of so many people, and because the ways we understand it have very real implications for the ways that we respond to it, there are often very strong feelings about the terminology that is used. For example, there is extensive disagreement about the term we should use to refer to people who experience distress. In recent years, the dominance of the medical perspective associated with psychiatry has meant that the term patient is very often used. Over the last 20 or 30 years, however, some of those who experience distress have organized themselves into activist groups and campaigned strongly for a change of terminology. They have argued that the term ‘patient’ implies a passive position where someone puts themselves in the hands of experts to be fixed. Some also object that the term inappropriately focuses almost exclusively on the medical and biological aspects of care (e.g. medication), rather than adopting a more holistic approach. As a result of these objections, some professionals now refer to those who use their services as clients. However, some groups have argued instead that they should be referred to as consumers (popular in the USA, Australia and New Zealand) or service users (popular in the UK), and many professionals have also taken up this language. But these terms have also been challenged. Some suggest that they obscure the fact that many people are not always willing consumers of mental health services, unlike the consumers of other goods and services: some, for example, will be receiving compulsory treatment. Such critics have sometimes suggested that the term recipient is more accurate. And yet others have argued that, because they have had to cope not only with their distress, but also with psychiatric interventions which they have experienced as negative or unhelpful, the term psychiatric system survivor is most appropriate. In short, then, there is no ‘right’ term to use and people in distress, like everyone else, have their own preferences and understandings. In this book we will usually use the term ‘service user’, since this is one of the terms most widely used in the UK. But we will also sometimes use other terms, where other people have used them or where the context demands it.

PROOF FROM DISORDER TO EXPERIENCE 7

Stigma and discrimination Language and terminology are important because of how they affect our thinking. However, they also matter in relation to service users and their experiences of distress because of the widespread discrimination to which such people are subject. The UK government regularly surveys public attitudes about ‘mental illness’: a survey (Office for National Statistics, 2010b) of 1,745 people revealed that • 78% of people agree that ‘people with mental illness have for too long been the subject of ridicule’ • 75% agree that ‘people with mental health problems should have the same rights to a job as anyone else’ • 87% agree that ‘we need to adopt a more tolerant attitude towards people with mental illness’ (a fall from 92% in 1994) At the same time, however, only 26% of people agreed that ‘most women who were once patients in a mental hospital can be trusted as babysitters’. Only 34% agreed that ‘less emphasis should be placed on protecting the public from people with mental illness’, and only 33% agreed that ‘mental hospitals are an outdated means of treating people with mental illness’. This survey suggests that the public have ambivalent feelings about service users and distress. One way of understanding this ambivalence is to see negative attitudes as an example of stigma. This approach draws upon sociologist Erving Goffman’s (1963) work Stigma: Notes on the management of spoiled identity, where he described the process of stigmatization as involving being viewed as socially deviant and linked with negative stereotypes. Since then, a number of researchers have drawn on this paradigm to suggest that experiencing distress or being given a psychiatric diagnosis can lead to one being stigmatized. Drawing on this insight, there has been a considerable amount of research into why mental distress is linked to negative attitudes. Research suggests that the development of negative attitudes begins early in life. Rose, Thornicroft, Pinfold and Kassam (2007) asked 472 14-year-old school students ‘What sorts of words or phrases might you use to describe someone who experiences mental health problems?’ They reported that around 250 words were mentioned by the young people, including terms such as nuts, psycho, loony, weird, freak, spastic and demented. In their interview study of 1,737 adults, Crisp, Gelder, Rix, Meltzer and Rowlands (2000) reported that their respondents commonly perceived people who had been given a diagnosis of schizophrenia as unpredictable and dangerous, even though about half of them knew someone with a mental health problem. Unfortunately, research also shows that such prejudiced views are even reported amongst doctors (Mukherjee, Fialho, Wijetunge, Checkinski & Surgenor, 2002) and may be made worse by some nurse training (Sadow, Ryder & Webster, 2002). Despite a huge amount of money spent on ‘anti-stigma’ campaigns the effects on public attitudes have been modest, leading some to suggest that attitudes about mental health may be different from other attitudes (Crisp et al., 2000). However, in a recent review, Read, Haslam, Sayce and Davies (2006) suggest that it may be the underlying assumptions of the anti-stigma paradigm which are the reason for the lack of change. These approaches are typically based on two assumptions, the first of which is that the public need to be taught to adopt a biomedical model of distress – to assume that distress is caused by diseases or illnesses of the brain or mind, and that

these illnesses are what psychiatric diagnoses describe. The second assumption is that this will result in less discrimination, because people will be more tolerant if they think that an unusual behaviour is caused by a medical illness or disease; otherwise, they might hold the person morally responsible. Another problem noted by some critics of these campaigns is that stigma is seen as caused by problematic attitudes located inside individuals, rather than as a product of, or reaction to, discrimination at a societal level – in a similar manner to sexism and racism (Sayce, 1998).

This poster was part of an advertising campaign by a UK mental health charity. What does it make you think? Does it stigmatize people with mental health problems, or does it challenge their stigmatization? What does it suggest to you about the causes of distress?

A number of studies have reported that, whilst the public may use medical terminology, they place a ‘greater emphasis on psychosocial than biogenetic explanations of schizophrenia’ (Read et al., 2006, p. 311). Moreover, contrary to the assumptions of the anti-stigma paradigm, biomedical explanations are associated with more negative attitudes and behaviour than psychosocial models, in which mental health problems are seen as psychological in nature and caused by adverse life events and circumstances (Lam, Salkovskis & Warwick, 2005; Mehta & Farina, 1997; Read & Harré, 2001; Read et al., 2006). Why might this be? One possibility is that, if unusual experiences or behaviours are seen as biomedical in origin, they become more mystifying and unpredictable. Conversely, if they are seen as the result of someone’s life experiences, they are perhaps more understandable. So public education programmes focusing on psychosocial explanations may well fare better than those that endorse biomedical approaches (see Figure 1.1).

PROOF 8

CONCEPTS

Biomedical approach

Psychosocial approach

Sees the person’s mental health problems as the main problem

Sees barriers in society as the main problem

Sees problems as a symptom of an underlying disease process and illness

Sees problems as an understandable response to adverse life events

Sees societal reactions as due to the stigma attached to having a mental health problem

Sees societal reactions as due to discrimination against a marginalised group (like racism, sexism etc)

Aim of public education is to remove perceived blame attached to the individual by ‘blaming’ the illness rather than the person

Rejects the relevance of notions of ‘blame’ and aims to promote diversity, reduce fear and increase empathy and understanding

Key public education slogan ‘Mental illness is an illness like any other’

Key public education slogans: ‘I’m crazy: so what?’ ‘It’s normal to be different’

Figure 1.1 Contrasting biomedical and psychosocial approaches to public education about mental health

Discrimination Although many people experience mental health problems, there is now substantial evidence that mental health service users experience significant discrimination across all areas of their lives (Sayce, 2000). For example, only 24% of people with long-term mental health problems were in work in England in 2003 – the lowest employment rate of any of the main groups of people with disabilities (Social Exclusion Unit, 2004). Almost half (47%) of Read and Baker’s (1996) respondents said that they had been abused or harassed in public. Berzins, Petch and Atkinson (2003) reported that people with mental health problems suffered much higher rates of verbal abuse and physical harassment than the general public, with much of it committed by teenagers and neighbours. Sadly, discrimination intrudes into even the most intimate relationships and can lead to many people with mental health problems feeling isolated (Mind, 2004) and being wary about telling other people about their own or another’s distress (Mental Health Foundation, 2000). There has also been an increase in community opposition to nearby mental health facilities. Research suggests that residents’ fears are fuelled by media reporting, and are associated – on occasion – with both vandalism and assaults (Repper, Sayce, Strong, Willmot and Haines, 1997). Another domain within which mental health service users experience discrimination is the media. Headlines such as ‘Schizophrenic Given Life for Murder’ (Daily Express, 24 March 2009), and terms such as ‘Psycho Cabbie’ (The Sun, 4 June 2010), serve to associate mental health service users with violence and fear and help to spread negative attitudes. Indeed, many commentators see disproportionate media reporting as an important maintaining factor in more widespread discrimination. In one study of a range of print and broadcast media, stories about homicides and crimes accounted for 27% of all coverage of mental health (Care Services Improvement Partnership/Shift, 2006). Messages about the risks of violence posed by people with mental health problems were present in 15% of stories, most of which implied the risk was high. News and entertainment media focus primarily on violence against others when addressing issues relating to mental illness, with these items receiving ‘headline’ treatment (Philo, 1994). These findings are robust (e.g. CSIP/Shift, 2006; Philo, 1996; Pinfold & Thornicroft, 2006) and influence the public’s fear of unpredictability and violence (Philo, 1996). Levey and Howells noted (1995) that perceived dangerousness was not as important as the perceived difference and unpredictability of people with a diagnosis of schizophrenia. Moreover, they

reported that reliance on fictional television was associated with higher ratings of unpredictability. Rose (1998) compared UK TV news coverage in the summer and winter of 1986 with TV news and other programmes between May and July 1992. Although she found variety in TV genres like soap operas and comedies, the category of danger was very frequent. For example, a third of all camera shots in her collection of TV news relevant to mental health dealt either visually or verbally with danger, violence and crime. Moreover, on the news, nearly two thirds of all stories involving those with psychiatric diagnoses fell into the category of crime news, although crime news accounts for only 10% of news coverage. As well as increasing the general public’s fear, negative media representations have an impact on people with mental health problems themselves. Half the respondents of a UK mental health charity’s survey of mental health service users said that their mental health had been negatively affected and a third said others had reacted negatively towards them as a result of such reports (Mind, 2000). The media bias against mental health service users is especially unhelpful because it largely ignores the available evidence. A UK study found that murders by mental health service users are infrequent and occur less than once a week (Large, Smith, Swinson, Shaw & Nielssen, 2008). Whilst this might sound alarming at first, it should be seen in the context of other statistics. First, only 10% of people convicted of murder in the UK are thought to have any mental health difficulties at the time of their crime (Department of Health, 2001), and 95% of all murders are committed by people who have never been given a psychiatric diagnosis (Institute of Psychiatry, 2006). Second, the number of people experiencing mental health difficulties at any one time is large – typically around one in six of the population, or – in the UK – roughly 7 million people. These figures show that the vast majority of murders are committed by people without mental health problems, and that the proportion of people with mental health problems who commit murder is extremely small. Other violent attacks by mental health service users (i.e. those not causing death) are similarly much less frequent than media reporting suggests, and when they do occur they are frequently also associated with the use of alcohol or other drugs (Fazel, Langstrom, Hjern, Grann & Lichtenstein, 2009). In fact, contrary to public fears, people with mental health problems are far more likely to be victims of violence than perpetrators; for example, they are six times more likely than the general population to die by homicide (Hiroeh, Appleby, Mortensen & Dunn, 2001). A US study of people experiencing

PROOF FROM DISORDER TO EXPERIENCE 9

psychosis found that they were 14 times more likely to be the victims of violent crime than to be arrested for committing violence themselves (Walsh et al., 2003). They are also far more likely to be a danger to themselves than to other people; for example, one influential study found that 90% of UK suicides involve people with mental health problems (Barraclough, Bunch, Nelson & Sainsbury, 1974). How might we change stigmatizing attitudes and discriminatory behaviour? As we have seen, promoting psychosocial rather than biomedical explanations may help. In addition, activists like Sayce (1998, 2000) have argued that lessons can be learned from broader disability campaigns. Here, campaigners argued that it was not a person’s disability which was the problem (as might be expected from an individualistic biomedical approach), rather it was the way in which society unintentionally created barriers by organizing the environment in a way which was convenient only for people without a disability. In the same way, rather than focusing on individual experiences of stigma, we might see public attitudes to service users – fuelled by inaccurate media reporting – as socially-created barriers to their acceptance by others.

What is distress? Throughout this book, then, we use ‘distress’ as a generic term to refer to all the phenomena and experiences that are sometimes called ‘psychopathology’ or ‘mental illness’. But, as we have suggested, this is not just about a preference for a different way of describing these experiences: it also signals a different way of conceptualizing them. We will now describe in more detail how we conceptualize distress, and how – as a concept – it differs from concepts of mental illness or psychopathology. When we talk about distress, we are talking about a highly variable and heterogeneous set of experiences. These experiences can include • strong or overwhelming emotional states, of various kinds, that disrupt everyday life and prevent people from functioning • habitual and repetitive patterns of acting – for example, in relation to personal hygiene, or to do with safety and security – that create anxiety if they are not carried out • experiences of seeing and hearing things that other people do not see or hear, or of holding beliefs that are considered by others to be unusual and extreme. In this book, we take these kinds of experiences as problems in their own right. This contrasts with the approach frequently taken in psychiatry, where service users’ talk of these kinds of experiences can very quickly get re-interpreted as nothing more than symptoms of an illness. In psychiatric settings, doctors are frequently listening out for particular patterns of difficulty in order to match the person’s experience with a pre-defined diagnostic category. However, this might mean that they miss some of the complexity and fluidity of people’s actual experiences of distress: in attentively looking for patterns of symptoms, they may fail to notice the ways in which people’s distress is linked to the circumstances of their situations. As a consequence, rich accounts of distress that engage with its meaning and detail in a person’s life may be difficult to achieve from within a psychiatric framework.

From our perspective, however, experiences of distress are part and parcel of the other experiences of everyday life. They do not form a separate, unitary category of symptoms that can be understood separately from everything else. Experiences associated with distress – just like every other experience – are bound up with social and material conditions, personal biographies, life events and relationships. And, just like every other experience, they are influenced by our biological capacities, by the many, variable potentials produced by our nature as living, organic beings. But if distress is not separate from other aspects of experience, and does not form a unitary category all to itself, how can we know where it starts and ends? How can we reliably and validly draw an objective line between distress – the province of services such as clinical psychology and psychiatry – and more everyday experiences of being unhappy, worried and so on? Simply put, our answer is that we cannot draw such a line. We do not believe that it is possible to produce a set of criteria or definitions that transcend history, place and culture and that can be used objectively to discriminate between those who are clinically distressed and those who are not. In the DSM, the existence of a distinct line between normal and abnormal is taken for granted – even though it is recognized that only appropriately trained expert psychiatrists might be able to determine exactly where it lies. By contrast, we believe that there is no value-free distinction between behaviours and experiences that are considered normal and those that are considered abnormal. Neither is there any universal standard against which people’s emotions, thoughts and actions can be judged, and by reference to which they can be categorized as deviant. On the contrary, the identification of distress as distress will always be entwined with prevailing cultural norms of emotionality, behaviour and morality. However, this does not mean that cultural norms are the sole criteria against which distress might be identified. Sometimes a person’s ways of acting or experiencing can make it difficult for them to live their lives as they would like, or can have a bad effect upon their physical health. When this happens, their behaviour is never somehow floating free of cultural norms: what we want to do in our lives, for example, is continuously influenced by the precepts, norms and values of our time and culture. Nevertheless, there are patterns of activity and experience which would be unhelpful or damaging in most circumstances. Gradually starving yourself – perhaps because you have come to believe that only by doing so can you begin to meet all of the many expectations placed upon you – will damage your physical health, no matter where or when you live. Similarly, being so profoundly miserable that you are unable even to get out of bed is likely to prevent you from achieving your goals, whatever those goals are. In the same way, experiencing angry and abusive voices that no-one else can hear is likely to make you frightened, confused and distracted, and this will probably occur to some extent even in cultures where voice-hearing is not as thoroughly stigmatized as it is in the West. So, whilst these dysfunctional or damaging consequences are definitely not separate from wider cultural norms and values, they do not arise solely because of them: they are also a product of specific patterns of experience and activity. To some extent, distress can also be identified with respect to the extent to which a person’s actions and experiences

PROOF 10 CONCEPTS

are unusual and inexplicable. Again, cultural norms play an important role here, and in two ways. First, almost by definition, norms refer to the ways of acting and experiencing displayed by the majority. However, there are difficult issues involved in trying to agree the threshold at which an experience becomes seen as clinically significant (see Box 1.2 for a discussion). Second, norms are relevant because we are far more ready to ascribe distress to people when their ways of being in the world do not make sense to us. When what people say or how they act is not only unusual but also seems to lack any obvious explanation, we are more likely to conclude that they are experiencing distress of some kind. In other words, it is not just the frequency or rarity of someone’s acts and experiences that counts – it is also the sense or the meaning that we are able to give to them. Another issue is that there are significant numbers of people who receive treatment from psychiatric or clinical psychological services but who do not want these interventions. Some might be experiencing the transient states of extreme euphoria and intense energy that psychiatrists call mania; others might be hearing voices that are friendly and supportive, rather than angry or abusive; yet others might be very unhappy, worried or confused, but have nevertheless come to believe that the treatments are not working, or that they produce as many difficulties as they solve. Some such people might end up receiving services, not because they themselves are distressed, but because their behaviours and experiences are distressing to others around them. Others may end up receiving services because their behaviour leads them to fall foul of the law. Again, cultural norms are highly relevant here: but in cases

1.2

BOX The problem of thresholds We have seen that one criterion for identifying experiences as mental health problems is how unusual they are. But what is the threshold beyond which an experience is considered so unusual that it is significant? This question is important, because research shows that some phenomena associated with distress are far more common than is usually supposed. Of a random sample of 7, 076 Dutch people, Van Os, Hannsen, Bijl and Ravelli (2000) reported that, whilst 3.3% had ‘true’ delusions (i.e. meeting all diagnostic criteria) an additional 8.7% had delusions that were ‘not clinically relevant’ – that is, they were ‘not bothered by it and not seeking help for it’ (van Os et al., 2000, p. 13). Similar findings have been reported in relation to hearing voices (see Chapter 11). Stein, Walker and Forde (1994) conducted a telephone survey in Canada to ask about experiences of social

like these those norms are either mediated by other people’s experiences, or codified in legal or other requirements. These examples show how the identification of distress can be a compassionate move, perhaps by attempting to keep safe someone who might otherwise be a danger to themselves. But they also show how distress is always bound up with the wider structures of power that organize our lives, and by which interventions might be imposed against our will. To summarize: distress is always conceptualized with respect to cultural norms, but these norms are not the sole criteria against which distress is understood. One consideration is that distress always has a subjective component, regardless of its location within culture. Another is that, intersecting with cultural norms, we also have • Judgements about the extent to which a person’s actions and experiences are harmful or dysfunctional • Judgements about the extent to which they are unusual • Judgements about the meaning of actions and experiences • The influence of power relations None of these judgements is simply objective, just as the operation of hierarchical power relations cannot simply be seen as ‘objectively’ correct. But whilst these judgements and influences do not escape the influence of cultural norms, they are not identical to them, either. Instead, they point to numerous ways in which the contexts, consequences and meanings of experience are part of its conceptualization as distress. They make it clear that distress is always socially and culturally positioned, that it will vary according to the specifics of time

anxiety, finding that 61% of respondents reported being much or somewhat more anxious than others in at least one of the seven social situations surveyed. However, if the threshold at which a person’s distress was considered clinically significant was moved, the prevalence of ‘social anxiety syndrome’ varied from 1.9% to 18.7%. Many diagnostic criteria are formulated without any empirical investigation of base rates in the general population. This may explain why there is a frequent disparity between numbers of people seen by mental health services and numbers of people in community surveys who meet diagnostic criteria. Moffit et al. (2010) have suggested that many estimates of prevalence in community surveys undercount because they rely on retrospective accounts. Their prospective study, which followed participants between the ages of 18 and 32 and interviewed them four times during this period, found prevalence rates for DSM diagnoses that were twice those of other national surveys. They conclude by suggesting that ‘researchers might

begin to ask why so many people experience a DSM-defined disorder at least once during their life-times, and what this prevalence means for etiological theory, the construct validity of the DSM approach to defining disorder, service delivery policy, the economic burden of disease, and public perceptions of the stigma of mental disorder’ (p. 907). Because there are cultural norms about what might be regarded as grounds for distress, where the threshold for distress is set will have a considerable impact. One US study has suggested that ‘about half of Americans will meet the criteria for a DSM-IV disorder sometime in their life’ (Kessler et al., 2005, p. 593). If half of the population experiences something, is it unusual? To some extent, this depends on one’s worldview. For example, Sigmund Freud, one of the founders of psychoanalysis, did not see it as his job to make people happy: instead he simply argued that ‘you will see for yourself that much has been gained if we succeed in turning your hysterical misery into common unhappiness’ (Freud & Breuer, 1895/2004, p. 306).

PROOF FROM DISORDER TO EXPERIENCE 11

and place, and will be patterned according to broader sociological variables such as socio-economic status, gender and ethnicity. Conceptualized in this way, distress is quite different from mental illness or psychopathology, both of which imply objective disease states that can be identified in ways that are distinct from cultural norms.

Why not abnormal psychology? Our claim that there are no objective criteria by which distress can be distinguished from other kinds of experience is a challenge to the idea that some kinds of experience – and perhaps even some kinds of person – are simply abnormal. But this is such a taken-for-granted idea that it even lends its name to the most commonly used title for textbooks like this one, which are typically described as books on abnormal psychology. This term is very widely used, perhaps because classifying some kinds of experience as abnormal makes it reasonable to describe them as expressions of psychopathology or mental illness. Since abnormal psychology is such a common term, we should explain why we do not use it in this book. Whilst the notion that trained professionals can use objective criteria to distinguish between normality and abnormality is perhaps comforting, it is nevertheless mistaken. Speaking very generally, formal definitions of abnormality can be classed as medical, as statistical, or as social – but whichever kind of definition we use, we encounter contradictions and problems. Each kind of definition excludes some phenomena we might intuitively want to define as psychologically abnormal, includes some we would not want to define as abnormal, or smuggles elements of subjective opinion into what are ostensibly objective judgements. For example, if we use a medical definition of normality, we will tend to class as normal those activities which contribute to health and wellbeing, and class as abnormal those that endanger life or wellbeing or which cause harm to bodily organs or tissues. But this means that many highly prevalent everyday activities – such as smoking, drinking alcohol, dieting, extreme sports, body-piercing and tattooing – would be classed as abnormal, because they all involve actual or potential damage to the body. If we use a statistical definition of normality, we will class as abnormal those activities, behaviours and characteristics that are, numerically, relatively unusual in a given population. Statistical definitions of normality derived from psychology sometimes use psychometric instruments, normal distributions and similar procedures by which to distinguish those who are abnormal from those who are not. But without also drawing on cultural values and norms (for example, in deciding which experiences to include in psychometric scales) statistical definitions will always generate contradictions, because some highly valued attributes – being a member of the royal family, perhaps, or excelling at sport – are statistically highly abnormal. If instead we use a social definition of abnormality, this will reflect the specific kinds of activities and experiences approved or disapproved of in that time and place, so will inevitably be subject to marked variation. This variation operates within as well as between cultures: groups and subcultures have their own norms of behaviour and conduct that sometimes differ significantly from those of the dominant or mainstream

culture (Hebdige, 1979). Social definitions recognize the culturally normative dimension of distress that we described above, but when we try to formalize them it becomes apparent that we also have to invoke other (typically unspecified) criteria to decide which social norms, when, and where, to use as the basis of our decisions. So concepts of normality and abnormality do not provide an objective basis for the identification of mental illness or psychopathology, and this in part explains why we have not relied upon these concepts in this book. But the term ‘abnormal psychology’ is nevertheless widely used, and seems acceptable to the majority of psychology lecturers and students. Despite this, there are other reasons why we choose not to describe this as a book about abnormal psychology.

Abnormal psychology is confusing and unclear One reason we haven’t used the term ‘abnormal psychology’ is that it is ambiguous: is it the psychology itself that is abnormal, or does the term refer to the psychology of abnormality? Common sense would suggest that it is the second of these options that most people have in mind; if so, this only leads to a second, thornier set of confusions. As we have already discussed, there is no straightforward, objective way to distinguish abnormal behaviours and experiences from normal ones. Even more fundamentally, though, it is impossible to easily identify a body of psychological theory and practice that is both exclusive to abnormality and unconnected with other topics. Psychological explanations in abnormal psychology tend to draw upon just the same kinds of paradigms and theories as other psychological explanations – biological, cognitive, behavioural, social, developmental and so on. It does not seem necessary to assume that the psychological processes that occur in distress are fundamentally different or abnormal in comparison to those that occur in other, supposedly normal, experiences. There are many successful psychological models of distress that draw upon established psychological theories and concepts such as learning theory, attribution theory, schema and so on.

Abnormal psychology is not consistently psychological A further way in which abnormal psychology is confusing is that it is not consistently psychological. Frequently, abnormal psychology entirely abandons psychology and turns instead to psychiatry. This is clearly demonstrated in the overall structure of most textbooks, which typically follow, more or less faithfully, the diagnostic categories associated with one of the major psychiatric diagnostic systems such as the DSM or ICD. But this necessarily means that the inconsistency also runs deeper: even where psychological explanations are offered, they are directed at problems already defined in psychiatric terms. So in abnormal psychology there is an unresolved tension between psychiatry and psychology, and frequent shifts from one to the other. Moreover, when this happens, abnormal psychology typically offers no rationale for this shift from a psychological mode of explanation and description to a medical, psychiatric one. In this textbook, we try to avoid these confusions by presenting consistently psychological accounts of distress. This does not mean, of course, that we entirely ignore psychiatry: this

PROOF 12

CONCEPTS

would be impossible, given that so much of the evidence we have about distress is associated with it. Nor does it mean that we ignore any of the multiple facets of distress, such as its biological, cognitive or developmental aspects. However, it does mean that we treat psychological explanations of distress as sufficient in their own right. Rather than subordinating them to psychiatry by applying them only to problems defined in the first instance as medical and psychiatric, we also use psychology to define the nature and character of people’s distress.

Abnormal psychology is unhelpful A third reason we haven’t used the term ‘abnormal psychology’ is that it is likely to be particularly unhelpful for many of the people who will be expected to study it. As we note throughout this book, distress is very common and it is likely that most readers will know someone who has experienced it (see Box 1.3). In this context, teaching that is framed from the outset as being about something abnormal will already import a range of assumptions that, for many readers, are likely to be difficult or unhelpful. It is hard to engage constructively with teaching that labels you, or the people you love and care for, as abnormal. Even more seriously, this unhelpful aspect of abnormal psychology is not confined to its likely effects upon the learning and teaching of psychology. Although the majority of people who study psychology do not go on to have careers in the profession, they will nevertheless draw upon what they have learned at other points in their lives. This means that they

1.3

BOX I know someone who has a mental health problem Many readers of this book will either know someone who has had a mental health problem, will have experienced a problem themselves, or may do so in the future. UK mental health campaigners suggest that about one in four people will, at some point in the course of their lives, experience clinical levels of distress. Elsewhere in this book, we ask whether such figures challenge common definitions of mental illness based upon notions of organic disease and dysfunction. For now, all we need to recognize is that such experiences are very common, so if you have experienced distress – or know someone who has – you are not alone. In a survey of students attending an abnormal psychology class in the US, Patricia Connor-Greene (2001) found that almost every student reported knowing someone with a mental health problem, that quite often students knew several

will tend to possess a limited and restrictive set of conceptual frameworks when they themselves, or people in their lives, encounter mental health problems. These limitations, and the assumptions of abnormality which they reproduce, may act as barriers to people’s ability to understand difficulties and respond to them appropriately. Of course, all teaching and learning starts from a set of assumptions about what we imagine to be the nature of the topic and what students need to learn about it. We do not imagine that by avoiding the term ‘abnormal psychology’ we have somehow written a textbook that is free from any assumptions – far from it. We simply hope that the assumptions we started from will prove more helpful and appropriate for psychologists and many others who wish to engage with this topic.

Isn’t this just anti-psychiatry? Some readers might consider that our arguments so far are ‘just anti-psychiatry’. By this, people mean the work of psychiatrists and others in the 1960s, like Ronald Laing in the UK and Thomas Szasz in the USA, both of whom were critical of the legitimacy of psychiatric claims. As we will see in Chapter 2, the so-called anti-psychiatrists were not a homogenous group, and there were important differences between the key figures. Moreover, both Laing and Szasz were unhappy with the term ‘anti-psychiatry’, and they were clearly not against all ideas and practices in this area, since they both continued to practise psychotherapy. Many modern abnormal psychology and psychiatry textbooks give the impression that the challenges raised by the

such people, and that the people they knew were most often family members. She observed that taking part in such a class is not ‘simply an abstract academic exercise; it is a potential source of knowledge and skills that could have a significant impact on students, families and friends’ (Connor-Greene, 2001, p. 211). We take this point seriously. Throughout the book we have sought to portray people in distress in a respectful manner, and to avoid an ‘us and them’ attitude. We have tried to investigate and present the evidence behind, for example, claims about particular mental health interventions, so that readers of the book can act as informed citizens when helping a family member to weigh up the pros and cons of different intervention options. When reading about mental health, one can easily start to recognize oneself in the descriptions of certain kinds of problem. As we will see in later chapters, studies of the normal population suggest that many mental health problems are normally distributed, such that a lot of us experience them at a low level (i.e.

in a manner which does not get in the way of our lives or cause significant difficulties for us or those close to us). Thus, if you feel that you are a little obsessive because you like things to be neat and tidy, it does not mean you have a disease called obsessive compulsive disorder. This self-recognition problem is very common. If you asked the other students in the class if they have started to question whether they have a mental health problem, we think it is likely they will say that they have too! If, however, you do have a problem that is long-lasting, and that is causing difficulties that get in the way of your life and causing you further distress, then you should consider seeking help. Most universities and colleges have mental health or counselling services, and these can be an appropriate place to start. For those who are not students, local voluntary services in your area can usually be identified by searching the internet. You could also try discussing your difficulties with your GP, who – if it is appropriate – will be able to refer you to more specialist services.

PROOF FROM DISORDER TO EXPERIENCE 13

anti-psychiatry movement were addressed with a new edition of the DSM in the 1980s. However, this new manual did not solve the more fundamental conceptual problems noted by these critics – for example, that value judgements are necessarily involved in definitions of mental illness, and that there is no clearly evidenced biological basis for mental illness, and thus no physical tests for (say) schizophrenia in the way that there are for infections or viruses. Moreover, there has been a considerable body of empirical research over the last fifty years which has cast new light on some of the debates which began in the 1960s. Throughout the book we will draw on this research to demonstrate that there are continuing problems with the validity and reliability of diagnostic constructs. Likewise, we will draw on this research to show that a focus on the experience of forms of distress can yield results that are valuable to service users, researchers and clinicians. It may help here to consider some of the debates in other areas of psychology, for example between different approaches to social psychology or between paradigms like learning theory and psychoanalysis. Here, too, there are debates about assumptive frameworks, key concepts, terminology and methodology. In these areas, too, we have had to accept that research is always, to some degree, a reflection of its time, affected by cultural norms and so on. Our contention is that this is also true in mental health, so throughout the book you will see debates analogous to those found in other areas of psychology. In short, there are some similarities between aspects of our approach and the ideas of the anti-psychiatrists, but there are also significant differences. This book reflects the findings of the nearly fifty years of research and discussion that has taken

1.4

BOX DSM-IV definition of mental disorder In DSM-IV each of the mental disorders is conceptualized as a clinically significant behavioural or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (a painful symptom) or disability (impairment in or more areas of functioning). This syndrome or pattern must not be merely an expectable and culturally sanctioned response to a particular event, for example the death of a loved one. Whatever its original cause, it must currently be considered a manifestation of a behavioural, psychological or biological dysfunction in the individual. Neither deviant behaviour nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of dysfunction in the individual. Reproduced in Stein et al. (2010, p. 1760)

place since the 1960s. The term ‘anti-psychiatry’ seems to exclude all of this more recent work, is simplistic, and carries far too much historical and conceptual baggage; for these reasons we would not use this label to characterize our approach.

From disorder to experience Most mental health textbooks, then, focus on psychiatric disorders; Box 1.4 shows how disorder is typically defined within psychiatry, and discusses some problems associated with such definitions. By contrast, in this book we focus on experience. By this we mean that we will describe and try to explain experiences of distress without presuming that they are always caused by an underlying disorder of some kind. We will treat the difficulties themselves as something to be explained, rather than attributing them to an underlying disorder that in fact may not even exist. In the last few years there has been a growing tendency for psychology to engage directly with the particularities of experience itself, rather than, for example, engaging with general biological or cognitive capacities. There have been three recent books on the psychology of experience, each one taking a slightly different focus. Ben Bradley (2005) emphasizes that experience is always relational and shaped by the simultaneous experiences of other people. He also discusses ways of thinking about the significance of time in relation to experience. Dave Middleton and Steve Brown (2005) show how our experience is made in part from our memories, exploring how they help give meaning to everything we see, hear and feel. Niamh Stephenson and Dimitris Papadopoulos (2007)

This definition raises many issues that recur throughout this book: whether or not distress should be seen as a medical or biological problem, the relationships between individuals and their culture, the kinds of reactions we should expect people to show to unpleasant but common experiences such as bereavement, and so on. Notably, however, the definition also displays a continual concern with notions of dysfunction, and this raises some complex issues. For example, Wakefield (1992) distinguishes between disorder and dysfunction. He argues that a disorder is a harmful dysfunction, and that what is considered harmful will be judged according to prevailing social norms. By contrast, a dysfunction – for example, of a cognitive mechanism designed to conduct a specific function – might be identified objectively, so is not subject to the same kinds of influences or biases. This suggestion is insightful: it avoids many of the difficulties associated with definitions of normality and abnormality whilst also recognizing that the notion

of disorder is inescapably social in character. However, as Kirk and Kutchins (1999) observe, we can only reliably identify a dysfunction if we can say with confidence what the function of a system or organ is meant to be. But in relation to human minds and brains, our knowledge of these functions is still remarkably limited. For example, we know that many neural systems frequently serve more than one function, that most basic abilities are enabled by multiple neural systems working in parallel, and that there are frequently many different neural pathways by which the same (or a similar) behavioural or cognitive goal can be reached. They argue further that many forms of distress are probably not dysfunctional in any simple sense: for example, that it may well be ‘natural’ and a sign that your neural systems are working as they should if you end up feeling deeply miserable because you have lost your job and have no immediate prospect of getting another.

PROOF 14 CONCEPTS

focus mainly on the ways in which experience is shaped by the wider power relations of society, relations which regulate our experience and – at the same time – create contradictions that can put us somewhat at odds with their requirements. These different perspectives on experience begin to show how it always spreads in two directions: ‘outside’ ourselves, into the social and material circumstances that give experience its character and content, and ‘inside’ ourselves, by way of the many thoughts, feelings and memories it consists of. In this book we will try to explore experience from both of these directions, in the hope that by doing so we can make even superficially baffling experiences more open to explanation. The alternative – attributing what we cannot readily understand to the effects of an underlying disorder – tends to produce unsatisfying, circular explanations: we know that Jenny has schizophrenia because she hears voices, and the reason she hears voices is because she has schizophrenia. Whilst the kinds of experiences we will consider are quite varied, they are all of the kinds that mental health professionals might encounter in the course of their work. At the start of this chapter we presented Bess’s story and suggested that her experiences are fairly typical of those that clinicians encounter. Here are some more examples: Dave is a 45 year old man who is frustrated with his career. Although he has a well paid, highly respected job and a comfortable home, he is dissatisfied with other aspects of his life and his negative feelings have recently started to become overwhelming. At work, Dave feels that his talents are not being recognized, and that his manager is a bully who does not take his suggestions seriously. In recent months, this situation has begun to preoccupy Dave’s thoughts. He has frequent trouble sleeping, and has started experiencing pains in his neck and back. His GP can find no physical cause for these pains, but since Dave recently began experiencing panic attacks he has referred him to a counsellor attached to the practice. Together with the counsellor, Dave has begun exploring how his responses to his manager are shaped by other experiences in his life. Ellie is a 19 year old woman who got pregnant when she was just 15, although she has not seen her son’s father since then. She has tried to provide her son with a stable home, but despairs that she is only surrounding him with the same kinds of instability and confusion that she experienced herself when she was growing up. For a long time now Ellie has felt very miserable, but she has come to believe that if only she had cosmetic surgery to make her body look ‘younger’, more attractive to men, she would feel much better. When her doctor would not refer her for cosmetic surgery of this kind, Ellie attempted suicide. Since then she has been taking anti-depressant medication and receiving cognitive-behavioural therapy. Mark is a 25 year old unemployed man who lives with his mother and stepfather in a poor suburb. He never knew his own father, who left home when he was small. His mother remarried and had a daughter with her new partner, and Mark grew up feeling that he always took second place to his sister. Following a long and angry argument with his stepfather, Mark has been lonely and miserable and has started locking himself into his room. Alone at night, he has begun to hear angry male voices criticizing him. Mark is terrified by these experiences, but has not told anyone about them because he fears that people will laugh.

Like all of the other examples in this book, these are fictional – they are not descriptions of real people. Nevertheless, they are fictions closely informed both by clinical practice and by the research literature describing mental health difficulties. This means that we can use them to draw out important issues that are relevant to our understandings of distress – for example, how people are socially positioned. Dave is a middle-class professional, whereas Ellie and Mark are less wealthy and have fewer resources. Studies show that the incidence of psychiatric diagnoses varies with wider economic and social conditions and is patterned according to sociological variables such as class or socio-economic status, gender and ethnicity. Similarly, there is much evidence that women are more likely to be given some psychiatric diagnoses than men, and that overall they are more likely to experience distress. Nevertheless, as our examples illustrate, at the individual level these influences appear complex and uneven. Ultimately, each of our examples is an attempt to reduce the messy complexity of a lived experience, in all its uncertainty and ambiguity, to a single narrative told from a specific point of view. Inevitably, doing this raises issues. For example, there are always other stories that could have been told: even though we have tried to illustrate something of the great diversity of distressing experiences, it is impossible to encapsulate the variety of experiences being lived out around us all the time. So we could have told many other stories; but we could also have told the stories we did tell in different ways. Mark’s stepfather, for example, might have told a story that emphasized Mark’s unreasonable behaviour, and described how he frequently becomes aggressive without any apparent justification.

Both psychiatry and psychology are imbued with interests – for example, those of commerce and professional status. Although the problems associated with these interests may be more acute in respect of psychiatry, psychology does not provide a neutral ground from which to approach distress

PROOF FROM DISORDER TO EXPERIENCE 15

This suggests that there will often be tensions between what people say about distress according to how they have experienced it, how they have been exposed to it, and how they have been encouraged to understand it. Moreover, these tensions will often have moral, ethical or political dimensions to them. This is only to be expected: partly because distress often first becomes a matter for intervention when people flagrantly breach everyday moral codes and expectations, partly because distress is associated with inequality, disadvantage, discrimination and prejudice, and partly because the stigma associated with it can be used to discredit or denounce the actions and pronouncements of individuals. Stories about distress (like all stories, in fact) are never neutral: they are always told from a point of view, and that point of view always reflects a set of interests. We have no definitive solution to these problems. We certainly cannot claim that the account we give in this book is somehow neutral, or that it fails to reflect our interests as academic and clinical psychologists. Instead, we have adopted two strategies to take account of these problems. First, we will continually emphasize the importance of all kinds of evidence when considering, weighing and assessing the claims made for different explanations of distress. And second, we have included in this book some of the views and perspectives of people who actually experience distress, so that our professional perspectives can be balanced by perspectives from those who have actually received mental health services.

All in the mind? By rejecting psychiatric disease categories we might appear to be denying the reality of people’s distress: if the categories aren’t real, are we saying that the distress isn’t real, either? This is not the case. We have not based this book upon psychiatric diagnoses because of the extensive evidence regarding their lack of validity, poor reliability, dubious empirical grounding and much-discussed conceptual difficulties (we discuss this evidence in much more detail throughout the book, especially in Chapters 4 and 5). In place of psychiatric diagnoses, we advocate consistently psychological explanations, but from a psychological perspective, people’s distress is just as ‘real’ as it is from a psychiatric one. The pejorative term ‘it’s all in her mind’ is sometimes used to imply that psychological distress should be something we can simply overcome by an effort of will. It is a moral judgement which ultimately implies that only those of weak character fall prey to psychological disorders. In this book we need to avoid such unjustified moralizing, whilst holding on to the idea that distress is fundamentally psychological. We can do so in a number of ways. First, we should recall that nothing is simply ‘all in the mind’. Mind, body and brain are intimately joined together, and anything that is ‘in the mind’ is simultaneously a state of the body–brain system. The denigration of psychological distress as being ‘all in the mind’, in other words, relies for its force upon the cultural commonplace of mind–body dualism. Mind–body dualism – also sometimes called Cartesian dualism – refers to a tendency, common in Western cultures and associated historically with the philosophy of René Descartes, to treat mind and body as distinct, separate substances with no necessary links between them. Second, we should recall that pain, such as that from a broken leg, is just as much ‘in the mind’ as distress, but we

Anything that is ‘in the mind’ is also a state of the brain and body

don’t understand it in these dismissive terms because there is a clear and visible explanation for its severity. Those who experience chronic back pain, by contrast, may also fall prey to such discrimination: having a visible cause for pain – or for distress – helps. Third, the experiences of distress that are categorized by psychiatric diagnoses are, in any case, overwhelmingly psychological in character. There are no reliable biological markers for different diagnoses, no blood tests or scans that can be used to make diagnoses of depression or schizophrenia. Instead, there are reports – usually verbal – of various kinds of experience: unusual beliefs, profound unhappiness, extreme agitation, hearing voices and so on. These experiences may well also have aspects that are visible in the person’s bearing and manner: people who are deeply unhappy, for example, often talk more slowly than other people, and sometimes more quietly. They may have difficulty thinking of words or concentrating on the flow of conversation, and may find it hard to motivate themselves. But the existence of these bodily elements does not necessarily mean that there is a physical disease called depression, although it does demonstrate, again, that psychological states are simultaneously states of the body and brain. Fourth, we should always keep in mind that even when people’s own actions seem to be unhelpful and self-defeating, this does not mean that they are simply responsible for their own distress. Putting this another way, just because how we respond to our distress can make a difference to the outcome, this doesn’t mean that individuals should be held personally responsible for failing to respond in what, from an outsider’s perspective, is the ‘correct’ manner. In actuality, most people’s room to manoeuvre is far more limited than it might at first appear, and many simply do not have the resources to deal with their situation in ways that are markedly different. Moreover, just like everyone else, when people experiencing distress make choices, they always do so with limited knowledge of their consequences: we can know what we do, but cannot so readily know all of the effects of what we do. Far from denying the reality of people’s distress, then, psychological explanations begin with this reality and attempt to understand how it has been constituted. In our view,

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CONCEPTS

only the existence of a cultural prejudice against psychological explanations for distress prevents this from being more obvious.

Models of distress In science, models are often used as an aid to thinking about and researching problems. Formal scientific models are derived from theories and bear a systematic relationship to them. There are also more ‘informal’ models that are most accurately located within a paradigm rather than a theory, and these are the kind of models typically used in relation to distress. We have already mentioned biopsychosocial, biomedical and psychosocial models of distress, but in the literature many more are described. Figure 1.2 shows some of the most commonly-cited models of distress, together with their most frequently used synonyms. Whilst for convenience we have named these models as though they were separate and distinct entities, you need to be aware that in actual practice things are far more confusing. For example, it is possible to conceive of the diathesis-stress model as a variant of the biopsychosocial model, because it attempts to unite biology, in the form of an organic vulnerability or diathesis, with the psychological and social influences that cause stress. However, it is equally possible to conceive of the diathesisstress model as a variant of the medical or psychiatric model, because it posits that clinical distress only arises in people who are medically (biologically) vulnerable. Likewise, some family systems models are also psychoanalytic; and many psychological models are cognitive as well as behavioural. Similarly, many people would see the biological model as being the same as the medical or psychiatric one, whereas some would differentiate these. Using models to understand distress can yield a number of advantages. Models simplify complex issues, making it easier to think about them and to generate ways of researching them empirically. They do this largely by selecting some aspects of distress as most relevant to enquiry, and others as less relevant: this assists with both theory and empirical research. Using a biological model of distress, for example, the primary

Biomedical (biological) Medical (psychiatric, illness) Diathesis-stress (stress-diathesis, stress-vulnerability) Behavioural Cognitive Humanistic (existential) Psychodynamic (psychoanalytic) Family systems Psychosocial (sociocultural) Biopsychosocial Figure 1.2 Models of distress

focus of study will be what occurs inside the brain and body of someone experiencing distress; other influences will only be important to the extent that they make a difference to the body and brain. Models also supply a mode of representation – an analogy or set of metaphors that is useful for communication and conceptualization. In the cognitive model, for example, the analogy is that the mind works like a computer, so we conceive of distress as caused by faulty information processing. In this way, models also organize events and phenomena into (possible) causal chains. If distress is cognitive and arises because of faulty information processing, the causal chains will implicate psychological mechanisms and strategies (attributions, perceptions etc.); if distress is biological, the causal chains will depend on biological phenomena such as features of the brain. However, these benefits can also become limitations. Because models are analogies or metaphors for distress, rather than actual distress, they can easily be over-extended. Once we begin to think of distress in terms of (for example) a cognitive model, we might be tempted to keep on thinking of it this way even when we encounter aspects that might be better explained in other ways. For example, although some aspects of being extremely sad can be conceptualized cognitively (in terms of a set of negative cognitive biases), other aspects are probably better explained by reference to biological or social processes. This might seem to imply that a biopsychosocial model is what is needed, and whilst in a superficial sense this is obviously true, in practice most biopsychosocial accounts are inadequate (we discuss this issue in Chapter 4, especially in Box 4.5). Another possible disadvantage of using models is that, in simplifying distress by focusing on what is most relevant from a given perspective, they might actually leave out what is most important, but we will never know this unless we start from the actual phenomena (the experience of being distressed, in all of its complexity and confusions) rather than from within the bounds of a model to which we have already made an intellectual or professional commitment. A final disadvantage is that models of distress can be misleading with respect to causality because they might imply sets of relations that, in actuality, do not exist. For example, a biological model of distress that emphasizes the role of hormones might give the impression that these hormones only interact with each other, and lose sight of the fact that levels of hormones also fluctuate according to external influences such as social and relationship status. There are also deeper conceptual issues with most commonly used models of distress because for the most part they accept boundaries that we might wish to question. For example, biological and social influences tend to be either kept apart or – when they are brought together – mediated by psychology. Whilst there is some sense in this, it then makes it very difficult to consider situations where biological and social influences might interact directly, without necessarily being psychologically mediated, such as in the development of an embryo in the womb, or in the very early days of a human infant’s life. Throughout this book we will sometimes have to make reference to models of distress, and you can use the table in this section to orient yourself toward them. However, whilst they can be useful, you should always bear in mind that they can also be misleading.

PROOF FROM DISORDER TO EXPERIENCE 17

Overview of this book This book is in two parts. The first part provides a foundation for the second by systematically setting out key concepts, debates and evidence. The aim of the first part is to supply a detailed account of distress that describes its character, identifies causal influences, and discusses responses to it. In the second part, we apply this account of distress to a subset of the most common kinds of mental health problems encountered by professionals in clinical psychology, psychiatry, social work and related disciplines.

Part 1 This part contains eight chapters which, read together, provide a consistently psychological account of distress. Although we frequently discuss psychiatric diagnoses in this part, we do not use them as explanations. Instead, we offer explanations that draw upon psychological theories and concepts, supplemented where appropriate with evidence and ideas from disciplines including neuroscience, anthropology, sociology, epidemiology and other relevant disciplines. In this way we provide an account of distress that avoids ‘jumping ship’ and uncritically importing wholesale a set of concepts and theories from psychiatry. Part 1 has eight chapters: Introduction (this chapter) History Culture Biology Diagnosis and Formulation Causal Influences Service Users and Survivors Interventions History: To understand why we have the ideas we do today it is vital to look at how those ideas were developed, so in this chapter we provide a survey of the different ways that distress has been understood and treated over the centuries. Our history shows how there have always been competing strands of explanation and treatment for distress, some primarily implicating the body and its organs and some primarily implicating experiences, meanings, thoughts and feelings. Culture: This chapter describes how distress differs between cultures. It discusses some of the great variability in the forms of distress, the variability in the ways that it gets linked to other aspects of experience, and the variability in the outcomes associated with it. As we have already suggested, distress is thoroughly bound up with culture, and this chapter illustrates the extent and consequences of this. Biology: Our approach to biology treats it as an inescapable part of distress, but does not make the unfounded psychiatric assumption that it is always the ultimate cause of people’s difficulties. In this chapter we explain why there are problems with biopsychosocial accounts of distress, and in their place offer an alternative view of the role of biology. We summarize evidence that supports our approach, drawing upon studies of attachment as well as upon recent work in psychology and neuroscience. Diagnosis and Formulation: Textbooks of ‘abnormal psychology’ are usually organized around systems of psychiatric diagnosis, such as one of the versions of the DSM. This chapter presents some of the evidence that psychiatric

diagnosis is not valid and reliable enough to provide a firm scientific basis for understanding distress. It then sketches an alternative, consistently psychological approach to classifying distress. Causal Influences: In some instances, the causes of a person’s distress might seem quite obvious; in others, they may seem mysterious or obscure. This chapter provides a detailed discussion of the notion of causality in relation to distress, showing how it is often more difficult to ascertain and understand than we imagine. We describe and evaluate the research methods used to establish causality in distress, and then review evidence showing that – regardless of the specific form that distress takes –it is associated time and again with a common set of causal influences. Service Users and Survivors: Mental health service users sometimes describe themselves as experts by experience. This chapter draws upon some of that expertise and describes how the service user movement in the UK has mounted a series of challenges to the treatments offered by services. A discussion of the work of the ‘Hearing Voices Network’ shows how service users are continuing to challenge conventional services by organizing themselves to provide viable alternatives to conventional therapies. Interventions: Here we describe the kinds of interventions for distress typically offered by Western mental health services. We describe psychiatric medication, psychotherapy, and community psychology interventions, using these to show how each offers different potential sources of help to people experiencing distress. A number of different mental health professionals are involved in offering interventions to people in distress – in the appendix to the book we describe some of the key professional groups and the kinds of settings within which they work.

Part 2 Part two of the book contains five chapters. In each one we discuss in detail one of the major kinds of distress that contemporary Western mental health services encounter. We had to make some difficult choices about how we should present this material. On the one hand, we did not want to organize the material around psychiatric diagnoses. On the other hand, we knew that many mental health modules are structured in this way. This meant that we needed to present our material in a way that was useful to as many people as possible. We have done this by structuring these chapters around broad forms of distress where there is some commonality in the underlying phenomenology of an experience. In psychology, phenomenology refers to exactly what an experience is like – what kinds of characteristics, features and subjective qualities it has. Reflecting some of its links with philosophy (phenomenology is also an important branch of philosophy), this usually means that efforts are made to include the bodily or embodied aspects of experience, as well as those usually described as mental or cognitive. What does this look like in practice? Well, for example, it means that Chapter 9, ‘Sadness and Worry’, deliberately treats together aspects of experience that are usually treated separately in books organized according to the DSM classification. In other books, these experiences are likely to be addressed in two separate chapters, one focused upon ‘Depression’ and

PROOF 18

CONCEPTS

the other focused upon ‘Anxiety Disorders’. Similarly, Chapter 11 on ‘Madness’ includes experiences that, in other textbooks, would be addressed separately in relation to psychiatric diagnoses such as schizophrenia and bipolar disorder. Although the number of different kinds of distress we discuss in this way is fairly small, they will account for the vast majority of the referrals received by UK mental health services. The chapters are Sadness and Worry Sexuality and Gender Madness Distressed Bodies and Eating Disordered Personalities Each of these five chapters is structured in a similar way, and each one builds upon the concepts and evidence laid out in Part 1 of the book. Within each of these chapters there are sections on history and culture, a summary of the psychiatric diagnoses typically given to people experiencing this form of distress, a review of the evidence regarding causality, and a description of the kinds of treatments and interventions available for this kind of distress.

will get a lot more out of reading all of them if you first read the chapters in Part 1.

Questions Each of the chapters has a set of questions associated with it. You can use these questions to check your own learning and make sure that you understand the material in the book in the way that we intend. There are guiding questions at the start of each chapter that will alert you to recurrent themes to keep in mind as you read. There are also summary or revision questions at the end, which you can use to check that your learning is proceeding adequately.

Boxes All through the book we use boxes to introduce additional material alongside the main text. Some of the boxes simply contain material that, although linked to the main text, is easier to explain separately. Other boxes contain discussions of key theories, concepts or issues which will recur throughout the book.

Key terms and concepts

How to use this book Sequence Because most ‘abnormal psychology’ textbooks are structured around the diagnostic categories of the DSM, they often do not make a sequential, structured argument. This means that it is usually quite easy to dip into them, regardless of the order of the chapters, in order to read about specific diagnoses. This book is a little different. In Part 1, especially, all of the chapters are linked so that together they provide a systematic argument that explains our approach to distress. The chapters in Part 2 are more like the chapters in other textbooks, in that it does not especially matter in which order you look at them. However, whilst these chapters can be read in isolation, you

You have probably already noticed that whenever we use any specialist terms or language for the first time, the term is printed in bold and a definition or explanation appears very close by – mostly immediately afterwards, occasionally just beforehand.

Stories and experiences Almost all of the chapters in this book start with a story about someone’s experience. As we have already explained, these stories are all fictional but, at the same time, they are informed by clinical practice and by close readings of the mental health literature. You can read them as a very quick and accessible way of orienting yourself to the concerns and issues that each chapter raises.

PROOF 409

INDEX

Note: Page numbers in bold refer to definition/concept; Page numbers in italics refer to figures; Page numbers followed by “b” indicate boxed material; Page numbers followed by “t” indicate tables. AA, see Alcoholics Anonymous Abnormality, see normality and abnormality abnormal psychology, 11–12 Abrahamson, L., Seligman, M. & Teasdale, J. cognitive theory of sadness and worry, 205–6 Academy of Gundishapur, 23b acceptance and commitment therapy, 176 accidie, 26, 195, 196 acculturation, 73 types of, 73 ACMD, see Advisory Council on the Misuse of Drugs Addington, Anthony, mad-doctor, 28 ADHD, see attention deficit hyperactivity disorder Adler, A., 178, 310 adoption studies, 81 on eating disorders, 297, 298–9 on psychosis diagnosis, 263, 268 Advisory Council on the Misuse of Drugs (ACMD) (UK) cannabis use and schizophrenia study, 85–6, 87 advocacy, service user/survivor-led, 147 African-Caribbean community in UK and compulsory treatment, 170 interventions for psychiatric diagnosis, 134 schizophrenia among, 72–3, 133 age causal role in sexual problems/dysfunction, 228 agoraphobia, 197 Alcock, C., 181 Alcoholics Anonymous (AA), 46 alexithymia, 297 alienists, 30, 34 Alleged Lunatics’ Friend Society, 22, 139 American Psychiatric Association (APA), 44 see also Diagnostic and Statistical Manual of the American Psychiatric Association American Psychological Association (APA) on electro-convulsive therapy, 275 membership growth, 45 amphetamine, 167 analogue experiments, 125 anger/rage and brain development association, 96–7 causal role in eating disorders, 297 see also emotions anorexia nervosa, 285 and cognition, 296 DSM criteria for, 286b Gull conceptualization of, 286

intrapersonal and interpersonal causal factors, 296 psychiatric diagnosis of, 289 antidepressants, 166–7 atypical, 214 effectiveness of, 213b and sexual problems/dysfunction, 230 see also tricyclic antidepressants anti-histamines, 43, 161, 164 anti-psychiatry, 4, 12–13, 47–8 coinage of term, 48 decline of, 50 and growth of service user action, 144 antipsychotics, 43, 159, 160, 161, 164–5 effects of, 162, 165–6 efficacy of, 164, 276 second-generation, 165, 276–7, 306 antisocial personality disorder (APD), 309 childhood antecedent of, 323 dangerousness and treatability of, 337 gender bias in diagnosis of, 327–8 interventions for, 336–8 see also borderline personality disorder anti-stigma campaigns, 7 ‘Changing Minds: Every family in the land’, 111 anxiety disorders in children, 204 in women, 195, 198 see also generalized anxiety disorder; sadness and worry APA, see American Psychiatric Association; American Psychological Association APD, see antisocial personality disorder approved mental health professionals, 169, 339 Aretaeus of Cappadocia on melancholy, 24 Association of Medical Officers of Asylums and Hospitals for the Insane (UK), 30 see also Royal College of Psychiatrists Association of Medical Superintendents of American Institutions for the Insane, 30 see also American Psychiatric Association asylum(s), 20 in 16th-18th century, 28–9 in 16th-18th century, modes of intervention, 29, 30 in 18th-20th century, abuses and reforms of, 31–2 in 19th century, 30 in 19th century, admissions and discharges, 32–4 decline of, 44

in Germany, extermination programmes, 39–40 Hanwell Asylum (London), 30, 33 Lincoln asylum (England), 30 maristans, 23b professionalization of management, 30–1 state responsibility of, 30 Asylum: A Magazine for Democratic Psychiatry, 52 Asylum Journal, 30 attachment theory, 37 role in distress, 128–9, 272 Schore’s, 95–8 Schore’s, limitations of, 97b attention deficit hyperactivity disorder (ADHD), 67b psychiatric medication for, 167 attributional style effects, 205–6 atypical antidepressants, 214 atypical antipsychotics, 165–6, 276–7 and weight gain debates, 306 auditory hallucinations, see voice-hearing Avicenna (Ibn Sina), 23b Basaglia, F., 46, 49 Battie, W. differentiation of types of madness, 29 Bayle, A. L., 34, 251 Beck, A. cognitive theory of depression, 43, 49, 207, 254–5, 278 Becker, H. notion of “moral entrepreneur”, 30 Bedlam, 22 in popular culture, 28 see also Bethlem Royal Hospital Beers, C. A Mind that Found Itself, 22–3 behavioural disinhibition, 329 behavioural genetics, 78–81 see also molecular genetics behaviourism, 37–9, 42, 174 behaviour therapy, 42, 174 for sadness and worry, 216 third wave therapies, 176 Benedetti, G., 277 Bentall, R., 50 cognitive account of sadness, 206 on Kraepelin’s diagnostic classification, 35 ‘Whig’ historical writing, 21b benzodiazepines, 168, 214 Berkson’s bias, 260 Bethlem Royal Hospital (London), 22, 195 750th anniversary of, 151b in popular culture, 28

PROOF 410 INDEX

binge eating disorders, 285 and cognition, 296 cognitive maintenance model of, 297 DSM criteria for, 286b psychiatric diagnosis of, 289 biological causation of distress, 76–81, 129–31 and clinical practice, 136 in context, 81–4 of eating disorders and weight concerns, 297–8 irrelevance thesis, 84–91 of personality disorders, 331–2 of sadness and worry, 208–11 of sadness and worry in women, 203 of schizophrenia, 262–4 of sexual problems/dysfunction, 230–1 biological psychiatry foundation of, 33–4 rise of, 34–6 biomedical model of distress, 7, 8, 76, 136 and attitudes association, 256–7 resurgence in 1970s and 1980s, 50 see also biological causation of distress bipolar disorder, 250 DSM-IV criteria for, 258 psychiatric medication for, 167 see also manic depression biopsychosocial model of distress, 4–5, 91, 262 problems of, 91b Bleuler, E., 102, 275 notion of schizophrenia, 35–6, 251–2, 253 on schizophrenia causality, 253 Bleuler, M., 260 Board, B. J. & Fritzon, K. notion of psychopathic personality disorder, 325 body, 15, 20, 23b anatomists’ conceptualization of, 26 and gender variance, 243–4 and sexual identity, 222 Western and Eastern perspectives, 69–70 body-brain system, 92 external influences on, 92–3 see also mind-body dualism body dissatisfaction and eating disorders and weight concerns, 291–2 body image causal role in eating disorders and weight concerns, 290–2 and prevalence of eating disorders, 288 Western perspective, 284, 285, 287 body image distortion, 291–2 body weight issues, see eating disorders and weight concerns borderline personality disorder, 309 causality in, 329–30 cultural bias in diagnosis of, 324–6 diagnostic criteria for, 106 diagnostic issues, 317 gender bias in diagnosis of, 327–8 interventions for, 333–6 and self-harm, 329b see also antisocial personality disorder Boskind-Lodahl, M. on self-esteem and eating disorders association, 293

Boyle, M., 50 on Kraepelin and Bleuler’s description of schizophrenia, 35–6 on problems in the use of the term ‘psychosis’, 255b BPS, see British Psychological Society Bradley, B. on contingency, complexity and chance, 122 brain, 77 abnormalities of, causal role in distress, 130 body-brain system, 92–3 hemispheric activation and experiences of sadness, 209 imaging studies of, 265 and schizophrenia association, 263–4 social and environmental influences on development of, 93–5 brain fag (culture-bound syndrome), 67b, 198 brainwashing, 40 Breggin, P. R. Toxic Psychiatry, 50 Breuer, J., 10b, 37 Brewin, C. dual representation theory, 210–11 Briggs, K. 310 Briggs-Myers, I., 310 British Psychological Society (BPS), 83, 120 membership growth, 45 Bronfenbrenner, U. ecological model of systems, 182 Brown, G. W. & Harris, T. O. studies on social inequalities and distress in women, 132 bulimia nervosa, 285 causality in, 292, 295, 297, 298 and childhood sexual abuse, 292, 295 DSM criteria for, 286b interventions for, 302–3 prevalence of, 290 psychiatric diagnosis of, 289 Burton, R. Anatomy of Melancholy, 195, 196 Cameron, E. ‘depatterning’ technique, 40 cannabidiol (CBD), 86–7, 88 cannabis, 86 illegal drug classification in UK, 85 early heavy use of, and psychotic experiences, 269–70 and schizophrenia association, 85–8 cannabis psychosis, 267 Caplan, P. notion of delusional dominating personality disorder, 109, 328 Care Services Improvement Partnership (CSIP)/Shift, 8 Cartesian dualism, see mind-body dualism Cartwright, S. A. on ‘disorder’ peculiar to negro slaves, 34b case study research on causality in distress, 126–7 Cassel Hospital (London), 335 categorical models of diagnosis, 4, 261–2, 321–3 Cattell, R., 310 causal attributions, 119

causality in distress, 35, 89b and clinical practice, 136–7 consequential madness, 29 controversies about, 134b family’s role, 42–3, 127–8 nature of, 120–1 necessary causes, 78b, 121 public opinion about schizophrenia causality, 256 recognized kinds of, 127–37 research difficulties, 124 research methods for studies on, 124–7 in sadness and worry, 201–5 social and cultural dimensions, 119–20 sufficient causes, 78b, 121 see also biological causation of distress; culture; gender; genetics; relational causation of distress; social causation of distress CBD, see cannabidiol CBT, see cognitive behavioural therapy Central Intelligence Agency (CIA) (US) interrogation methods and psychiatry use, 40 ceremonial histories, 21b Cerletti, U., 39, 275 Cervantes, Miguel de. Don Quixote, 27, 28 CFS, see chronic fatigue syndrome Chamberlin, J., 50 On Our Own: Patient Controlled Alternatives to the Mental Health System, 51, 144 Chesler, P. Women and Madness, 21b Chiarugi, V., Italian physician, 29 childhood abuse and trauma and attachment theory, 95–9, 128–9 causal role in personality orders, 328–30 causal role in psychosis, 268–9, 274 causal role in sadness and worry, 205, 211–12 causal role in sexual problems/dysfunction later in life, 231–2 and dissociation, 272 and traumagenic neurodevelopmental model of psychosis, 271 see also sexual abuse in childhood China epigenic effects study, 92b neurasthenia diagnosis, 71, 196–7 political abuse of psychiatry, 41 prevalence of clinical depression, 58 chlorpromazine, 43, 164–5 Christianity faith healers connected with, 59b view of madness, 25–6 chronic fatigue syndrome (CFS), 196, 197 see also neurasthenia Churchill, W., 39, 47 CIA, see Central Intelligence Agency circadian rhythms causal role in sadness, 209–10 cisgender, 223, 242–3 Clare, A. W. Psychiatry in Dissent, 50 classical conditioning of reflexes, 38 in phobias, 202b, 206–8 client-centred therapy, 42 clients/consumers, see service user/survivor(s)

PROOF INDEX

clinical psychologists, 339 clinical psychology vs. community psychology, 182t growth of, 44–5 professional culture of, 58 and schizophrenia, 253–5 clothing and gender variance, 243 cognitive analytic therapy, 136, 334 cognitive behavioural therapy (CBT), 43, 61, 174 for antisocial personality disorder, 337 for eating disorders and weight concerns, 301–3 number needed to treat (NNT) criterion for, 189 practitioners of, 177 for psychosis, 278–9 for sadness and worry, 215–16 for sexual problems/dysfunction, 230–1 cognitive psychology downplay of biological causation of distress, 84–5 cognitive research on eating disorders and weight concerns, 295–6 on psychological mechanisms involved in psychosis, 272–4 cognitive therapists, 339 cognitive therapy, 43, 174 collectivist societies selfhood in, 59 view of somatization, 70–2 Colney Hatch Lunatic Asylum (London), 33 communication deviance, 268 community care, 44 in UK, success/failure of, 46 community psychology, 137, 179, 180–1 effectiveness of, 182–4 interventions, 184–8 theoretical framework of, 181–2 community treatment order (CTO), 147, 169 co-morbidity, 106–7 clarifications in DSM-5, 112b in DSM-III schizophrenia, 260 in personality disorders, 320–1 compulsory psychiatric treatment, 159, 168–9 campaign against (Kiss it!), 151b, 185 ethical dilemmas, 169 opposition to, 147–8 recipients of, 170 rise in use of, 171 ‘sectioned’, 56, 169 concordance (genetics), 78–9 studies, 79–81 conduct disorder, 323 biopsychosocial model of, 332 diagnostic criteria for, 106 Conolly, J., English physician, 30 consequential madness, 29 consumer evidence, 144, 148 contingency and causality in distress, 121–4 control (over one’s life) causal role in eating disorders, 288, 290–1, 292–3, 295 conversion (reorientation/reassignment) therapy, 224 Cooper, D., 144 Psychiatry and Anti-Psychiatry, 48

Cooper, M. cognitive maintenance model of binge eating, 297 correspondence bias, 119 cosmetic surgery and enhancement of self-esteem and sexual pleasure, 222 Costa, Jr., P.T. & McRae, R. R. five factor model of personality, 310, 312b cothymia, 200 Cotton, H., 39 counselling psychologists, 339 counsellors, 339 countertransference, 333 Creative Routes (group), 151b crime, see violence and crime Cristal, R. & Tupes, E. five-factor model of personality, 310 Cromby, J. notion of transactional scripts, 207b Crow, T. two factor model of schizophrenia, 260 CSIP/Shift, see Care Services Improvement Partnership/Shift CTO, see community treatment order Cullen, W., professor of the institutes of medicine, 27 cultural identity significance in psychosis development, 72–3 see also ethnicity/ethnic groups culture, 56–7 and biological causation of distress, 82 consumer culture, 60b cross-culture perspectives of psychiatric diagnosis, 108 and definitions of normality, 61–2 and eating disorders/weight concerns, 287–9, 290–7 and experiences of distress, 9–10, 255–6 and experiences of sadness and worry, 196–8 and large-scale institutionalization, 33 and personal agency, 135–6 and personality, 312–13 and personality disorders, 323–6 and schizophrenia, 64–5 and self, 59–61 and sexuality, 222 and sexual problems/dysfunction, 227–8 Western vs. non-Western societies, 58–9 culture-bound syndromes, 66–7, 108 eating disorders and weight concerns, 287 of sadness and worries, 197–8 Damasio, A. R. somatic marker hypothesis, 207b dangerous and having a ‘severe personality disorder’ (DSPD), 337 Davenport, C., eugenicist, 39 DBT, see dialectical behaviour therapy decompensation, 67 degenerationist theories, 33, 39 de-institutionalization, 22, 46 in UK, 44 delusions, 6, 10b cognitive research on, 273 content of, and childhood abuse association, 269, 270b debates about, 261b

411

Locke’s view of, 27 prevalence of, 257 dementia praecox, 35–6, 252 Deniker, P., 165 depatterning, 40 depression biological causation thesis, 76–7 culture-specific forms and diagnosis of, 71 vs. melancholy, 196 psychiatric diagnosis of, 200 psychiatric medication for, 166 Descartes, R. mind-body dualism, 15, 26–7, 69 Determinants of Outcome of Severe Mental Disorder (DOSMed), 64–5 Deutsch, A. Shame of the States, 44 diagnoses, see medical diagnoses; psychiatric diagnoses Diagnostic and Statistical Manual of the American Psychiatric Association (DSM), 5b, 47, 103 changes in diagnostic categories, 47 dimensional assessment approach proposal, 111, 112b eating disorder category, 285 notion of delusion, 261b notion of gender variance, 242b paraphilias category, 220, 238–9 personality disorder category, 314, 315t personality disorder category, criticism of, 315–16, 319–20 sexual deviation category, 47, 221–2 sexual problems/dysfunction categories, 226b task force on culture, 58 see also psychiatric diagnoses Diagnostic and Statistical Manual of the American Psychiatric Association, fourth edition (DSM-IV), 58 bipolar disorder and schizophrenia construct, 258 culture-bound syndromes, 66 definition of mental disorder, 13b descriptive assessment approach, 111 gender identity disorder construct, 244b, 245–6 Global Assessment of Functioning Scale (GAF), 261 list of paraphilias, 239b Organic Mental Disorders category, 104 personality disorder construct, 312–13, 315t personality disorder construct, revisions of, 322b Sexual and Gender Identity Disorders category, 221 Sexual Disorders Not Otherwise Specified category, 222 see also psychiatric diagnoses diagnostic categorization, 46 1900–1945, 34–6 alternative approaches to, 261–2 modern attempts at, 46–7 pharmaceutical companies’ influence on, 43–4 for schizophrenia, reliability and validity issues, 259–61 dialectical behaviour therapy (DBT), 176 for borderline personality disorder, 334–5

PROOF 412 INDEX

diathesis-stress model , 16, 34, 76, 254 of schizophrenia, 262–3 dichotic listening, 206 DID, see dissociative identity disorder dieting, 284, 291, 292–3, 302 see also starvation dimensional models of diagnosis, 4 of personality disorders, 321–3 of psychosis, 261–2 discrimination as consequence of paraphiliac behaviours, 241 as consequence of psychiatric diagnosis, 110 and gender identity, relation with distress, 223–4 service user/survivor’s campaigns against, 149–50 service user/survivor’s liaison with media on, 146 service user/survivor’s opposition to, 142 and stigma, 7–9 disease-centred model of drug action, 160, 164, 168 disorganized attachment relationship, 95–7, 99 dissociation, 66 association between psychosis, trauma and, 272 cultural construction of, 66 and early relational trauma, 95–7 and religious experiences, 68 Western diagnostic criteria of, 67 dissociative identity disorder (DID), 66 in US, 67–8 distress, 9–11 association between eating disorders and other forms of, 299 causal influences, see causality in distress developments in classification of, 34–6 experiences of, 9–11, 13, 14–15 expressions of, 66 as a form of mental illness, 20, 57–8 ‘in between, just short of, and left over’ categories of, 107 Islamic approaches to, 23b problem of thresholds, 10b psychological perspective of, 15–16 terminology, 6 see also eating disorders and weight concerns; madness; personality disorders; sadness and worry divination, 58 in Zambia, 59b Dix, D., American social reformer, 30 Dodge, K. A. & Petit, G. S. biopsychosocial model of conduct disorder, 332 domestic violence causal role in distress, 129 in heterosexual couples, 328 victims of, 133, 203 see also violence and crime dopamine hypothesis of schizophrenia, 76, 77, 99, 264–5 DOSMed, see Determinants of Outcome of Severe Mental Disorder drapetomania, 21b, 33, 34b drug-centred model of drug action, 160–1, 168

DSM, see Diagnostic and Statistical Manual of the American Psychiatric Association DSPD, see dangerous and having a ‘severe personality disorder’ dual representation theory, 210–11 dysaesthesia aethiopica, 34b dysfunction, 13b dyspareunia, 226 early maladaptive schemas, 331 eating disorders and weight concerns, 285 causality in and maintaining factors of, 290–300 and economic growth association, 60b gendered phenomena, 291, 292–4 historical and cultural context of, 286–8 interventions for, 300–6 psychiatric diagnosis of, 109, 289–90 Western forms of, 285–6 eating disorders not otherwise specified (EDNOS), 285 DSM criteria for, 286b psychiatric diagnosis of, 289 Eberl, I., 39 ecological model of systems, 182 ECT, seeelectro-convulsive therapy EDNOS, see eating disorders not otherwise specified EE, see expressed emotion EEA, see equal environment assumption efficacy and effectiveness, 189 of antidepressants, 213b of anti-psychotics, 164, 275–7 of cognitive analytic therapy for borderline personality disorder, 334 of cognitive behavioural therapy for eating disorders and weight concerns, 302–3 of cognitive therapy for psychosis, 278–9 of community psychology, 182–4, 185 of early intervention for psychosis, 279 of electro-convulsive therapy, 172, 275 of family therapies for eating disorders and weight concerns, 304 of medication for antisocial personality disorder, 337–8 of preventative interventions for antisocial personality disorder, 336–7 of preventative interventions for borderline personality disorder, 335 of psychiatric medication for borderline personality disorder, 336 of psychiatric medication for eating disorders and weight concerns, 304–6 of psychological interventions for antisocial personality disorder, 337 of psychosocial interventions for psychosis, 277–8 of psychotherapies, 174–6 of psychotherapies for sadness and worry, 217b of schema-focused therapy for borderline personality disorder, 334 separated vs. conjoint family therapy, 304 of service-level interventions for borderline personality disorder, 336 of Sex Offenders Treatment Programme (SOTP), 241b

of social interventions for borderline personality disorder, 335 electro-convulsive therapy (ECT), 39, 171–2, 214–15, 275–6 Ellis, A. rational therapy, 43 emic knowledge, 61 emotions causal role in eating disorders and weight concerns, 296–7 causal role in sexual problems/dysfunction, 229 and culture, 62 see also sadness and worry emotion work, 203 empowerment, 146–7, 150–1, 182, 279–80 of people with learning disabilities, 186–7 encephalitis lethargica, 35–6 endogenous opioids, 298 England care of insane in 16th-18th century, 28 compulsory treatment, 169–71 increase in number of patients in 19th century, 33 non-restraint practices in 19th century, 30 psychiatric diagnosis in, 63b Time to Change campaign, 149, 150 see also United Kingdom environments/environmental influences, 80b on brain development, 93–5 and genes, 76 Rose’s lifelines model, 76, 88–92 twin studies, 79–81 see also interpenetration epidemiology/epidemiological studies, 60 of cannabis use and schizophrenia diagnosis, 87 of causality in distress, 126 of social inequalities, 132–3 WHO’s cross-cultural study of psychological problems, 62–3 epigenics, 92, 92b, 131 equal environment assumption (EEA), 80, 263, 298 Esquirol, J.-É. Mental Maladies, 34 ethics of compulsory treatment, 169, 189 of force-feeding, 301 of physical interventions for sadness and worry, 214–15 ethnicity/ethnic groups causal role in distress, 133–4 compulsory treatment for, 170 and psychiatric diagnosis association, 72–3, 108 and schizophrenia diagnosis association, 267 etic knowledge, 61 eugenics, 33 and Nazi genocide, 39–40, 275 proponents of, 39 experiences and biology, 76 and culture, 60–1 enabling vs. causing of, 89b perspectives on, 13–14 phenomenology of, 17–18 experiences of distress, 9–11, 13, 14–15

PROOF INDEX 413

experiences of service users/survivors redefinition of, 142–3 experimental research method for causality in distress studies, 124–6 expressed emotion (EE), 65, 268 high EE, 128 Eysenck, H., 310 Fairburn, C. transdiagnostic approach to eating disorders and weight concerns, 301–3 Fallon, J. on genetics role in personality disorders, 332–3 family causal role in distress, 42–3, 127–8 causal role in eating disorders, 299 causal role in personality disorders, 328–30 causal role in sadness and worry, 203–4 childhood abuse and sexual problems/ dysfunction, 228–9 and expressed emotion, 65 parental absence and psychosis development, 72–3 parental absence and schizophrenia diagnosis, 267 and schizophrenia diagnosis association, 267–8 temporal specificity and distress, 95–8 family studies, 81 on schizophrenia, 262–3 family therapies, 42–3 for borderline personality disorder, 335 vs. cognitive behavioural therapy for eating disorders, 303 for eating disorders and weight concerns, 303–5 systemic approaches, 179 Fanon, F. The Wretched of the Earth, 48 feminist family therapy for eating disorders and weight concerns, 304 Fenichel, O., 178 first person narratives, 21–4 five-factor model of personality, 310–11, 312b flashbacks, 199, 210–11 see also post-traumatic stress disorder flooding, 216 fluoxetine, 214 formulation, 102, 114 for eating disorders, 301 limitations of, 115–16 and psychiatric diagnoses, 115 for psychosis, 280–1 purposes of, 114–15 see also psychiatric diagnoses Foucault, M., 27 Folie et Déraison: Histoire de la Folie à l’Âge Classique, 28–9, 48 Foundation Resonance (Stichting Weerklank) (Netherlands), 50, 70b France developments in classification of distress, 34 homogenization of insane, 28–9 Napoleonic Code, 32 psychiatric diagnoses, 63b

free association, 37, 173 Freeman, W. psychosurgery technique, 43 Freire, P., 188 notion of conscientization, 188 Freud, S., 10b, 20, 253, 271, 310 psychoanalytic techniques of, 37, 173 Friends of Insane Persons, 22 functional diagnoses, 78 functional redundancy, 98 fundamental attribution error, 119 GABA, see gamma-aminobutyric acid Galen of Pergamum, 24 gamma-aminobutyric acid (GABA), 214 causal role in experiences of worry, 210 gay affirmative therapies, 224 gay liberation movement, 47 Gazzaniga, M. S. research with split-brain patients, 93 gender causal role in distress, 133 causal role in personality disorders, 326–8 causal role in sadness and worry, 203 childhood abuse and sexual problems/ dysfunction, 232 and eating problems and weight concerns, 291, 292–4 and learning disabilities, 186 and sex, 222–3 and sexual problems/dysfunction, 228 see also sexuality gender identity, 221, 247 and discrimination, relationship to distress, 223–4 gender identity disorder, 221 in children, diagnostic criteria, 246b diagnostic criteria issues, 243b, 244–6 gender reassignment surgery/sex reassignment surgery, 243, 246–7 diagnostic criteria issues, 245 gender variance and body, 243–4 and distress, 242b terminology and concepts, 242–3 see also gender identity; transgender generalized anxiety disorder, 198 and life events, 204 psychiatric diagnosis of, 200 psychiatric medication for, 214 and social inequality, 201–2 general paralysis of the insane/syphilis, 31 genetics causal role in distress, 78–81, 130–1 causal role in distress, 18th century views, 29 causal role in eating disorders, 297 causal role in personality disorders, 332–3 causal role in sadness and worry, 211 causal role in schizophrenia, 262–3 causal role in sexual problems/dysfunction, 231 gene, 90b see also lifelines: Rose’s model of genome-wide association studies (GWAS), 81 German psychiatry classification of distress, 34–5 and Nazi genocide, 39–40 glossolalia (speaking in tongues), 68

Goffman, E. Asylums: Essays on the Social Situation of Mental Patients and Other Inmates, 48 Stigma: Notes on the management of spoiled identity, 7 Gottesman, I., 79–80 Green Belt Movement (Kenya), 184 Griesinger, W., 34 Gull, W. conceptualization of anorexia nervosa, 286 GWAS, see genome-wide association studies Hage, P., 50, 152 hallucinations, 6 cognitive research on, 272–3 content of, and childhood abuse association, 269, 270b fictional representation of, 28 prevalence of, 262 Hanwell Asylum (London), 30, 33 Harper, D. on debates about delusions, 261b Hartley, J., 169 Having a Voice (Manchester: organization), 146 healers, 58, 59b, 69 shamans, 61–2, 69 hearing voices, see voice-hearing Hearing Voices Network (HVN), 70b, 145, 152–5, 280 Henderson Hospital (Sutton), 335 heritability (h2) index, 80b heteronormativity, 247 Hickling, F., 72 Hill, R. G., English physician, 30 Hippocrates, 24 ‘On the disease of young women’, 286 history of distress, 19–54 of eating disorders and weight concerns, 286–7 of personality disorders, 309–10 of personality theory and its problems, 310–12 of psychiatric diagnosis, 102–3 of psychiatric diagnosis of personality disorders, 314 of sadness and worry experiences, 195–6 of schizophrenia, 35–6, 251–3 of sexuality, 221–2 Hogarth, W., 28 Holland, S. notion of social action therapy, 187–8 Holmes, G., 184 home care in 16th-17th century, 28 in developing countries, 65 homosexuality psychiatric view of, 47, 221–2 Hopi people sadness amongst, 197 hormones causal role in sexual problems/dysfunction, 231 Horney, K., 178, 310

PROOF 414 INDEX

hospitals in 16th-18th century, 28 in 1950s-1960s, 45b Cassel Hospital (London), 335 de-institutionalization, 46 Henderson Hospital (Sutton), 335 Pilgrim State Hospital (Brentwood, US), 44 St. Elizabeth’s Hospital (Washington, DC), 48 Tavistock Clinic (London), 37 Winwick Hospital, (Warrington, England), 33, 45b see also asylum(s) HSRC, see human sexual response cycle Huber, W., 53b human activities enabling and causal influences, 90–1, 122 role of language in, 92–3 humanistic and existential psychotherapies, 42, 174 practitioners of, 177 human sexual response cycle (HSRC), 225 humoral model of distress, 21, 24–5, 26 HVN, see Hearing Voices Network hypervigilance, 72 hypnotism, 37 hysteria, 37 and gender association, 21b, 221 ICD, see International Classification of Diseases imaging techniques in neuroanatomy and biochemistry studies, 264–5 incidences, 56 of schizophrenia, 64, 131 of somatization, 70–1 individualism, 58, 59 infantile sexuality, 37 Ingleby, D., 178 inner speech, 93 Institute of Psychiatry (London), 86, 149 institutionalization and asylum system, 32–4 insulin coma therapy, 39 integrated formulation, 114 integrated model of distress, 137–8 International Classification of Diseases (ICD), 5b, 47, 103 personality disorder category, 314, 315t prevalence of most common ICD-10 diagnoses, 62–3 proposal for dimensional assessment approach, 111 International Pilot Study of Schizophrenia (IPSS), 64, 65 International Society for Psychological and Social Approaches to Psychosis (ISPS), 277 International Study of Schizophrenia (ISOS), 64, 65, 260 interpenetration, 76 body and social influences, 92–3 genes and environmental influences, 89–91 the interpreter, 93 interventions, 158–90 17th-19th century, 27, 28, 29–30 in 18th century asylums, 29 1900-1945, 34–6

for Black, minority and ethnic groups, 134 for child sex offenders, 240b–1b early intervention, 279 for eating disorders and weight concerns, 300–6 for gender variance, 243, 245, 246–7 guidelines for borderline personality disorder, 334, 335, 336 incorporation of causal influences, 136–7 for madness, 274–81 ‘moral’ (psychological) methods, 29–30 for personality disorders, 333–8 post-1945, 42 for sadness and worry, 212–17 service user/survivor involvement in, 146–7 for sexual problems/dysfunction, 234–7 see also community psychology; compulsory psychiatric treatment; efficacy and effectiveness; physical interventions; psychiatric medication; psychological therapies/ psychotherapies introspection, 37 IPSS, see International Pilot Study of Schizophrenia Islam holistic view of distress, 23b, 27 ISOS, see International Study of Schizophrenia ISPS, see International Society for Psychological and Social Approaches to Psychosis Italy de-institutionalization, 46 increase in number of patients in 19th century, 33 Jahoda, M., 180 James, W., 310 Japan eating disorders, 60b, 288 ‘fox possession’, 61–2 incidences of somatization, 71 taijin kyofusho syndrome, 61, 197, 198 Jaspers, K. psychiatric diagnostic classification of, 102–3 Jaynes, J. notion of bicameral mind, 152 jinn (culture-bound syndrome), 67b Johnson, V., see Masters, W. & Johnson, V. Joseph, J., 79–81 Jung, C., 37, 103, 271 Kagan, C. on temporal plasticity, 99 Kaya House (weekend crisis resource) (London), 146 kayak-angst (culture-bound syndrome), 197 Kemberg, O. transference-focused psychotherapy, 334 Kempe, M. first person narrative of distress, 22 Keseys, K. One Flew Over the Cuckoo’s Nest, 48 Kiesler, D. J., 310 Kingsley Hall (London), 48 Kinsey, A., 223b Kleinman, A. diagnosis of neurasthenia, 71, 196–7

Kleinplatz, P., 238, 239, 241 Knight, T., 169 Kohut, H., 310 koro (culture-bound syndrome), 67b Kraepelin, E., 275, 310 classification of distress, 35, 102, 103, 252–3 conception of schizophrenia, 35–6, 251–2 study of psychosis in Java and Europe, 62, 70 on symptoms and outcomes of schizophrenia, 253, 254b, 260–1 Kraff-Ebing, R. categorization of sexuality, 223b labelling theory, 48 Laing, R. D., 12, 107, 127–8, 144, 178 The Divided Self, 47–8 language role in human thinking and actions, 92–3 language of distress, 5–6, 107–8, 111 championing of new terminology, 142–3 new terminology, 140b Lasegue, C. on wasting diseases, 286 Latin America community psychology, 180 law and legislation on mental health (France), 32 law and legislation on mental health (UK) 18th-20th century, 31, 32 1983-2007, 53t on compulsory treatment, 44 Medical Act of 1858, 31, 32t Mental Health Act, 1983, 337 Mental Health Act, 2007, 142, 147–8, 159, 169, 337 law and legislation on mental health (US), 51 learning disabilities empowerment of people with, 186–7 Leary, T. interpersonal circumplex model of, 310, 311 Lee, S. on association between control and eating disorders, 288 legitimacy of psychiatry and diagnostic classification, 35, 103–4, 108–9 post-war period, 46 lesbian, gay, bisexual, transgender, queer and questioning (LGBTQQ) gay men and sexual problems/dysfunction, 233b liberation movement, 47 and mental distress, 223–4 see also gender identity; transgender LGBTQQ, see lesbian, gay, bisexual, transgender, queer and questioning Liddie, P. on psychotic symptoms, 260 life events adversity and psychosis association, explanatory models, 271–4 adversity and schizophrenia diagnosis association, 267–71 causal role in eating disorders and weight concerns, 295 causal role in personality disorders, 330 causal role in sadness and worry, 204 causal role in sexual problems/dysfunction, 229

PROOF INDEX

lifelines, 76 and eating disorders, 298–9 and madness, 274 and personality disorders, 332–3 Rose’s model of, 88–92 limbic kindling, 210 Lincoln asylum (England), 30 linkage studies, 81 Linnaeus Genera Morborum, 34 literature representation and understanding of madness, 27–8 lithium, 167 lobotomy, see prefrontal leucotomy Locke, J. notion of insanity, 27, 29–30 Lombroso, C. degenerationist theory of, 33 Lord, C., mental hospital attendant, 44 loss of personal meaning, 110–11 lunatic(s) etymology of, 20 preservation of public order and, 28–9 Lyons, J. concept of self-contained individual, 310 MAC-UK, see Music and Change programme madhouses in 16th-18th century, 28 see also asylum(s) Madhouses Act, 1774 (England), 31, 32t madness, 6, 250–1 Battie’s types of, 29 classical Greek approach to, 24–5 cultural constructions of, 69 historical construction of, 251 fictional representation of, 28 Foucault on conceptions of, 48 large-scale institutionalization of, 32–4 stigma and discrimination, 255–6 see also distress; psychosis Mad Pride (organization), 150, 151b major tranquilizers, see antipsychotics male erectile dysfunction, 227 manic depression Kraepelin’s conception of, 35, 252 psychiatric medication for, 167 see also bipolar disorder MAOI, see monoamine oxidase inhibitors Marín-Baró, I., 180 marriage and long-term relationships impact on mental health problems, 65–6 Marx, K. on asylums, 32–3 masochistic personality disorder, 109 diagnostic criteria for, 109b Masson, J. Against Therapy, 37 on therapist role, 177 Masters, W. & Johnson, V., 234 sensate focus exercises, 236 on sexual response, 225 masturbation, 236 May, R., 169, 274 MBCT, see mindfulness-based cognitive therapy McRae, R. R., see Costa, Jr., P.T. & McRae, R. R.

Media as carriers of culture, 82 causal role in eating disorders and weight concerns, 290, 291 discrimination against mental health service users, 8 Hearing Voices Network liaison with, 154b service users/survivors’ liaison with, 146 Medical Act of 1858 (UK), 31, 32t medical diagnoses, 104–5 vs. psychiatric diagnoses, 105–6 purposes of, 103 see also psychiatric diagnoses medical model of distress promotion by pharmaceutical industry, 234–5, 251 and psychiatric diagnoses, 102 service users/survivors movement opposition to, 142, 279–80 melancholy classical Greek descriptions of, 24, 195 historical recognition of, 195–6 see also sadness and worry mental disorders DSM-IV definition of, 13b Mental Health Act, 1959 (UK), 44 Mental Health Act, 1983 (UK), 337 Mental Health Act, 2007 (UK), 142, 147–8, 159, 169, 337 Mental Health Media, 146 Open Up initiative of, 149 mental health nurses, 339–40 mental health professionals, 339–40 and client power relations in psychotherapies, 177–9 integrative practitioners, 174 negative attitudes towards those diagnosed with personality disorder, 333 Mental Hygiene movement, 23 mental illness, 5–6 public attitude about, 7–9 Szasz on, 48 see also distress mentalization-based treatment, 330, 335 Mental Patients Union (MPU), 51–2 metacognition, 93 migration, 72 and incidences of psychosis, 72–3 mind “all in the mind?”, 15–16 bicameral mind, 152 Eastern traditions’ views on, 69–70 Plato’s views on, 24 theory of mind (ToM), 273 WHO’s African mind study, 62 see also psyche mind-body dualism, 15, 26–7, 69 Mind (charity), 388, 143, 149, 252b MindFreedom International, 51, 151b mindfulness-based cognitive therapy (MBCT), 216 Mind, Rethink and Together (charities), 144, 149, 150 Mischel, W. critique of personality theories, 310, 311–12 models of distress, 16 and attitudes association, 256–7 biomedical model, 7, 8, 50, 76, 136

415

biopsychosoical model, 4–5, 91b, 262 historical context, 22 humoral model, 21, 24–6 integrated model, 137–8 limitations of, 16 pathoplastic model, 56 psychogenic model, 21, 24, 27, 29–30, 37, 43 psychosocial model, 7, 8 sociogenic model, 21, 43 somatogenic model, 21, 24, 26–7, 33, 34–6, 37 molecular genetics, 78, 81 and eating disorders, 299 search for schizophrenic gene, 263 Money, J., 238 Moniz, A. E. development of prefrontal leucotomy, 39 monoamine oxidase inhibitors (MAOIs), 166, 209, 213–14 monoamine imbalance causal role in sadness, 208 mood stabilizers, 160 moral management, 29–30 Morel, B. Treatise on Physical and Moral Degeneration, 33 Moser, C., 238, 239, 241 Mosher, L., 278 Soteria approach of, 277–8 MPU, see Mental Patients Union Mullins-Sweatt, S. N., see Widiger, T. A. & Mullins-Sweatt, S. N. multiple personality disorder, see dissociative identity disorder Music and Change (MAC-UK) programme, 181 narrative therapies, 178–9 nasogastric feeding/force-feeding, 300–1 National Committee for Mental Hygiene, 23 National Health Service (NHS) (UK), 42 community psychology, 181 influence on development of clinical psychology, 45 National Institute for Health and Clinical Excellence (NICE) (UK), 159, 174, 182, 183b, 212 on CBT efficacy for eating disorders, 302 criticisms of, 183b guidelines on antisocial personality disorder, 330 guidelines on borderline personality disorder, 329–30 intervention guidelines for antisocial personality disorder, 336–8 intervention guidelines for borderline personality disorder, 334, 335, 336 intervention guidelines for eating disorders, 300 recommendations for ECT, 275–6 National Self Harm Network (UK), 145 Nazi Germany mass sterilization and extermination programmes, 39–40 neurasthenia, 22–3 in Eastern hemisphere, 66, 71, 196–7 neuroleptics, see antipsychotics neurologie, 26

PROOF 416

INDEX

neuroses, 5b, 37 forms of, 102–3 neurotransmitters causal role in distress, 76–8, 129–30 causal role in eating disorders, 298 causal role in personality disorder, 331–2 causal role in sadness and worry, 209–10 effects of psychoactive drugs on, 161 imaging studies, 264 social influences on development of, 94–5, 96 NHS, see National Health Service NICE, see National Institute for Health and Clinical Excellence No Force (group), 142 non-consensual sex, 224 normality and abnormality, 11 cross-cultural perspectives of, 61–2, 108 eating problems and weight concerns, 285–6 in sexuality, 220–1 Nuremberg Code, 40 Nuremberg ‘doctors’ trial’, 40 obesity, 284, 285 occupational therapists, 340 Oedipus complex, 37 oestrogen, 231 operant conditioning, 42, 278 for eating disorders and weight concerns, 301 organic diagnoses, 78 organisms and environment, see interpenetration original madness, 29 outer speech, 93 paedophilia, 238–9, 239b interventions for, 240b–1b pairwise concordance, 79–80 panic attacks, 199, 202b catastrophic misinterpretation in, 206 cognitive behavioural therapy for, 216 paranoia, 20 ‘healthy cultural paranoia’, 326 Kraepelin’s conception of, 252–3 paranoid delusions cognitive research on, 273–4 paraphilias, 220, 221, 237–9 debate on specific characteristics of, 239, 241 and discrimination association, 241 and distress association, 241 parenting and effects of early relational distress on brain development, 95–8 good enough parenting, 95 see also family Parkinson’s disease, 35 pathoplastic model of distress, 56 patients, 6 see also service user/survivors Pavlov, I. on classical conditioning of reflexes, 37–8 penicillin, 31 Perceval, J. A Narrative of the Treatment Received by a Gentleman during a State of Mental Derangement, 22

persecutory delusion, see paranoia personal agency and meaning, 135–6 personality disorders, 309 causality in, 323–33 diagnostic criteria for, 106 history and cultural context, 309–13 psychiatric diagnosis of, 314–23 psychiatric diagnosis of, bias in, 324–5, 327–8 stigma attached to, 110 personality theories, 310–12 Petersen, D. A Mad People’s History of Madness, 22 Petit, G. S., see Dodge, K. A. & Petit, G. S. pharmaceutical industry influence on shaping of diagnostic classification, 43–4 pervasive role of, 251 promotion of medical model of sexual problems/dysfunction, 234–5 research funding, 82 pharmacology, see psychopharmacology pharmacotherapy for sexual problems/dysfunction, 236–7 see also psychiatric medication phenomenology of experience, 17–18 phentolamine, 236–7 Philadelphia Association, 48 phobias causality in, 201, 202b and classical conditioning of reflexes, 206–8 list of, 199b systematic desensitization of, 216 physical interventions during inter-war period, 39 for gender variance, 243, 245, 246–7 for madness, 274–6 psychosurgery, 43, 168, 215 for sadness and worry, 214–15 see also psychiatric medication; psychological therapies/ psychotherapies Pick, A. diagnosis of dementia praecox, 35 Pilgrim State Hospital (Brentwood, US), 44 Pinel, P., French physician, 27, 29, 30 Plato, 20 tripartite division of soul, 24, 37 political dissidents confinement of, 40–1 politics view of biological causation of distress, 83 popular culture representation and understanding of madness, 28 representation of psychological therapies, 43 possession and trance states, 68 post-encephalitic Parkinsonism, 35–6 post-natal depression, 203 postpsychiatry, 50 post-traumatic stress disorder (PTSD), 47, 207–8 and war experiences, 270–1 poverty and distress association, 132 and schizophrenia diagnosis association, 266–7 and survivor predicament, 143b

Powell, E., UK Minister for Health, 44, 46 predictive validity of psychiatric diagnosis, 107 prefrontal leucotomy, 39, 43, 168, 275 presentist histories, 21b Present State Examination, 62 prevalence rates, 257–8 of ‘chronic neuroleptic users’, 166 of distress across cultures, 62–3 of eating disorders and weight concerns, 289–90 of eating disorders and weight concerns across cultures, 287–8 of personality disorders, 313–14 of personality disorders by gender, 327 of personality disorders, problems with, 314–16 of sadness and worry, 200–1 of schizophrenia, 257–8, 265 of sexual problems/dysfunction, 225, 228b preventative interventions, 281, 334, 336–7 primary prevention, 281 private madhouses England, 17th century, 28 probabilistic causality, 121–2, 123 probandwise concordance, 79, 80b prodrome, 279 professional cultures, 57–8 in Zambia, 59b professionalization, 30 of asylum management, 30–1 see also legitimacy of psychiatry professional users, 148 Psichiatrica Democratica (Democratic Psychiatry), 49 psyche Freud’ s model of, 37 Plato’s tripartite division of, 24 psychiatric abuse, 40–2 psychiatric diagnoses consequences for service users, 109–11 differences between England and France, 63b differences between formulation and, 116t differences between medical diagnoses and, 105–6 of eating disorders and weight concerns, 109, 289 functional diagnoses, 78 history of, 102–3 organic diagnoses, 78 of personality disorders, 314–23 of personality disorders, cultural bias in, 324–5 of personality disorders, gender bias in, 327–8 problems of, 106–8 question of purpose of, 112–13 responses to problems of, 111–12 of sadness and worry, 200 of sexual problems/dysfunction, 225–7 as social judgement, 108–9 see also Diagnostic and Statistical Manual of the American Psychiatric Association; formulation; International Classification of Diseases psychiatric medication, 159, 160–8 for antisocial personality disorder, 337–8 for borderline personality disorder, 336

PROOF INDEX

causal role in sexual problems/dysfunction, 230 current classification of, 165t for eating disorders and weight concerns, 304–6 evidence for, 162–4 models of drug action, 160–1 for psychosis, 275–7 for sadness and worry, 212–14 types of, 164–8 psychiatrists, 339 psychiatry challenges to, 1970-present, 49–53 and Cold War, 40–2 professional culture of, 57–8 see also German psychiatry; Western psychiatry and psychology psychoactive drugs, 161–2 psychoanalysis, 173 ascendancy of, 44 vs. behaviourism, 38–9 birth of, 37 on causality in sadness, 206 notion of personality, 310 vs. psychodynamic psychotherapies, 173 psychodynamic psychotherapies, 173, 177–8 psychodynamic theory, 271–2 psychogenic model of distress, 21, 24, 27, 29–30, 37, 43 psychological therapies/psychotherapies, 136, 159, 173–9, 189 1900-1945, 34–6 for antisocial personality disorder, 337 for borderline personality disorder, 334–5 efficacy and effectiveness of, 174–6, 217b feminist approaches to, 178 number needed to treat (NNT) criterion, 189 post-1945, 42–4 public’s preference for, 274 for sadness and worry, 215–16 for schizophrenia, 277–8 therapist-client power relations in, 177–9 types of, 37–9, 42, 173–4 psychology origin myths in, 38b see also Western psychiatry and psychology Psychology in the Real World project, 184–6 psychopathic personality disorder, 325–6 psychopathology, 5–6 see also distress psychopathy causality in, 330–1 ‘successful psychopaths’, 325–6 psychopharmacology, 209 birth of, 43–4 see also psychiatric medication psychosis, 6, 250 and adversity, 271–4 alternative research approaches to, 261–2 cultural construction of, 66 forms of, 102–3 impact of marriage/long-term relationships on, 65 interpretations in European societies, 70b psychosocial interventions for, 277–81 significance of migration in development of, 72–3

use of the term, 255b and violence, 8–9 see also distress psychosis risk syndrome, 112b psychosocial model of distress, 7, 8 of schizophrenia, 265–71 psychosurgery, 43, 168, 215 psychotherapists, 339 PTSD, see post-traumatic stress disorder public opinion about causality of schizophrenia, 256 about distress, 7–9 causal beliefs and attitudes, 256–7 purging, 284 qualitative research on causality in distress, 127 Rachman, S. technique of response prevention, 42 racial isolation and psychosis development, 72 randomized controlled trials, 162 for drug efficacy, 162–4 for eating disorders and weight problems, 305–6 for efficacy of psychotherapies, 175–6 rational emotive behaviour therapy, 43 reason and unreason, 26–8 Reclaim Bedlam (group), 151b recovery approach, 280 Reid, J., physician, 33 Reil, J. C. ‘psychiaterie’, 34 relapse prevention for child sex offenders, 240 for eating disorders and weight concerns, 302 relapse rates, 268 and antipsychotics usage, 166, 276 body image distortion causal role in, 300 and mood stabilizers usage, 167 and problematic parenting, 268 relational causation of distress, 127–9 and clinical practice, 136 and personality disorders, 317–18 see also childhood abuse and trauma; family; life events; social causation of distress; sexual abuse reliability of personality order diagnosis, 318–20 of psychiatric diagnosis, 106 of psychosis diagnosis, 259 religion and madness, in the middle ages, 25–6 and self-starvation, 286 religious experiences and dissociation, 68 representation of service users/survivors, 148–9 research on causality in distress, 124–7 on causality in distress, difficulties, 124 cross-cultural, 108 on efficacy of psychotherapies, 174–6 facilitation and support of Hearing Voices Network, 154b funding and pharmaceutical companies, 82 on peer support amongst service users/ survivors, 183–4

417

on prevalence of personality disorders, 314–16 and self-interest, 83 service user/survivor involvement in, 145 responsible clinicians, 169, 340 retrograde amnesia, 214 Rhazes (al-Rāzi), 23b Ribot, T.-A., 310 risperidone, 276, 277 Ritalin, 167 Rogers, C. R. client-centred therapy, 42, 136 Romme, M. & Escher, S., 280, 281 work on voice-hearing, 50, 70b, 152–3 Rose, D., 7, 46 study on TV news coverage on mental health, 8 Rose, S. lifelines model, 76, 88–92, 93 notion of norm of reaction, 98 notion of temporal plasticity, 98 on temporal plasticity and distress, 98–100 Royal College of Psychiatrists (UK), 30, 44, 83, 151b anti-stigma campaign, 111 on electro-convulsive therapy, 276 Royal Psycho-Medical Association (UK), 30, 44 see also Royal College of Psychiatrists Rudin, E., 40 Rush, B. tranquilizing chair, 27, 28 Russel, G. Maudsley method of intervention for eating disorders, 304 sadness and worry, 194–5 causality in, 201–12 contemporary forms of, 198–200 and eating disorders association, 289 historical and cultural context, 195–8 interventions for, 212–17 prevalence and distribution of, 200–1 psychiatric diagnosis of, 200 Sakel, M. insulin coma therapy, 39 Samelson, F. on little Albert study, 38b SANE, see Schizophrenia A National Emergency Sargant, W., 40 Scheff, T. J., 108 schema-focused cognitive therapy (SFCT), 334 schizophrenia, 50 among British African-Caribbean community, 72–3 biological causation thesis, 76–7, 99, 264–5 and clinical psychology, 253–5 cross-cultural differences in course and outcome of, 64–5 differences in psychiatric diagnosis of, 63b dimensional vs. categorical approaches, 261–2 double-bind theory of, 42 DSM criteria for, 105, 106, 258 epigenic aspects of, 92b genetic predisposition to, 262–3 impact of marriage/long-term relationships on, 65–6

PROOF 418 INDEX

schizophrenia – continued physical interventions for, 275 prevalence of, 257–8, 265 psychiatric medication for, 276–7 psychodynamic perspective of, 272 psychosocial causation, 265–71 psychotherapies for, 277–81 traditional conceptualization of, 35–6, 251–4 traditional conceptualization of, problems with, 259–61 Schneiderian, 64, 253 sluggish schizophrenia, 41 views on Internet, 252b Schizophrenia A National Emergency (SANE), 141 Schneider, K., 40 ‘first rank symptoms’ of schizophrenia, 64, 103, 253 school refusal syndrome, 67b Schore, A. attachment theory, 95–8 attachment theory, limitations of, 97b secondary prevention, 281 sedatives, 43 seduction theory, 37 selective placement bias, 263 selective-serotonin reuptake inhibitors (SSRIs), 166, 208, 212–13 side effects of, 167 self and culture, 59–61 de-personalization or de-realization, 199 dissociation and multiple selves, 66, 67–8 Egyptian model of, 20 Islamic approaches to, 23b see also psyche self-advocacy groups, 139–40 in Netherlands, 70b in UK, 70b self-defeating personality disorder, 109, 109b, 327–8 self-esteem and eating disorders and weight concerns, 293 self-harm, 169–70 question of symptom or coping strategy, 329b ‘selfish genes’, 90–1 Seligman, M., see Abrahamson, L., Seligman, M. & Teasdale, J. sensory deprivation, 40 serotonin imbalance causal role in depression, 76–8, 209 service user/survivor(s), 139–40 discriminatory experiences of, 8–9 empowerment of, 146–7, 150–1, 182, 186–7, 279–80 experience-based experts’ perspective on psychosis, 274 first person narratives of, 22–3 peer support amongst, 183–4 perspective on personality disorder diagnosis, 316–17 perspective on psychiatric diagnosis, 113b psychiatric diagnosis consequences for, 109–11 terms used to refer, 140b

and therapists’ power relations in psychotherapies, 177–9 service user/survivor involvement in anti-discrimination activities and campaigns, 149–50 in anti-discrimination and media work, 146 in arts and creativity, 146 in consultation and monitoring, 144–5 and government, 150 problems and challenges of, 149 in research, 145 in service provision, 145–6, 280 in training and education, 145 service user/survivor movements, 140 diversity of actions and views of, 140–1 problems and challenges of, 148–9 shared beliefs and experiences, 141–2 in UK, achievements, 146–7 in UK, origin and influences, 51–2, 143–4 in US, origin and influences, 50–1 sex/sexual activities, 222–3 and consent, 224 and distress, 224 sex therapy, 235–6 sexual abuse, 227b and diagnosis of psychosis, 270 pre-pubescent ‘seduction theory’, 37 and social inequality, synergistic causation effects of, 123b substance-dependence and, 87–8 sexual abuse in childhood, 227b causal role in distress, 227b causal role in distress later in life, 129, 205 causal role in eating disorders, 295 causal role in sexual problems/dysfunction later in life, 228–9, 232 and content of hallucinations association, 269, 270b and dissociation, 67, 232 and eating disorders association, 292 formulation, 115b reliability of disclosures of, 269 and substance-dependency problems association, 87–8 see also childhood abuse and trauma sexual arousal variations in, 237–8 sexual disorders, 220 sexual functioning, 225 sexuality classification of, 223b cultural context, 222 and gender, 223 historical considerations of, 221–2 ‘normal’ and ‘abnormal’, 220–1 see also gender sexual orientation discrimination and distress, 223–4 sexual problems/dysfunction, 220, 224 causality in, 227–30, 233–4 diagnostic problems of, 238–41 interventions for, 234–7 prevalence of, 225, 228b problems in diagnosis of, 233 psychiatric diagnosis of, 225–7 sexual skills development of, 236

Shakespeare, W., 27, 28 Macbeth, 195 shellshock, 37 see also post-traumatic stress disorder Shingler, A., artist, 151b, 185 Shorter, E., 37 notion of biological psychiatry, 33–4 Shotter, J. notion of joint action, 122 Showalter, E. The Female Malady, 21b sick role, 110 Skinner, B. F. operant conditioning theory, 42, 278 Snezhnevsky, A. notion of sluggish schizophrenia, 41 social action therapy, 187–8 social capital, 182 social causation of distress, 122, 131–4 and clinical practice, 136–7 synergistic interaction, 123b see also relational causation of distress; social inequalities social drift/social selection, 131, 266 social inequalities causal role in distress, 132–3 causal role in personality disorders, 328 and gender association, 133 and madness, 266–7 and sadness and worry association, 201–2 and sexual abuse, synergistic interaction effects of, 123b Socialist Patients’ Collective (Sozialistisches Patientenkollektiv) (SPK), 52, 53b social policy conception of distress and, 21 social reform and reformers of asylums in mid-19th century, 30 social relations and body-brain system, 92–100 and distress association, 183–4 ‘joint action’ in, 122 social sciences downplay of biological causation of distress, 84–5 social status and serotonin levels, 209 social workers, 339 Society for the Protection of Alleged Lunatics, 22 sociogenic model of distress, 21, 43 socio-therapy, 48 Socrates, 24, 251 Socratic dialogue, 174 Solanus of Ephesus, 195 somatization, 66, 70–1 culturally specific forms and diagnoses of, 71–2 somatogenic model of distress, 21, 24, 26–7, 33, 34–6, 37 soul, see psyche Soviet Union political abuse of psychiatry, 41 Space to Write project, 184 spell-binding, 161 spirit possession zar, 68

PROOF INDEX

SPK, see Socialist Patients’ Collective (Sozialistisches Patientenkollektiv) Spring, B., see Zubin, J. & Spring, B. SSRI, see selective-serotonin reuptake inhibitors Stainton Rogers, R. & Stainton Rogers, W. critique of personality theory, 311 Stangl, F., 39–40 start/stop squeeze techniques, 236 starvation DSM criteria for, 286b historical precursors of, 286–7 see also dieting Steiner-Adair, C. discrepancy theory, 293 St. Elizabeth’s Hospital (Washington, DC), 48 sterilization, compulsory, 39, 275 sterotactic subcaudate tractotomy, 215 stigma, 7–9, 110, 255–6 stimulants, 43, 167–8 straitjackets, 29, 30 substance use causal role in sexual problems/dysfunction, 230 and childhood abuse/trauma association, 87–8 and schizophrenia diagnosis association, 269–70 substitute experiments, 125–6 subvocalization, 156b, 273 survey methods for studying causality in distress, 126 survivors, see service user/survivor(s) Survivors History Group, 50 survivors poetry, 146 Survivors Speak Out (advocacy group), 145 Sweden compulsory sterilization, 39 Sydenham, T., physician, 34 symptoms and signs, 104 see also Diagnostic and Statistical Manual of the American Psychiatric Association; International Classification of Diseases; psychiatric diagnoses synergistic causation, 123b systematic desensitization, 42, 216, 236 systemic therapies, 179 Szasz, T., 12, 41–2, 128, 144 on the concept of ‘mental illness’, 107–8 The Myth of Mental Illness: Foundations of a Theory of Personal Conduct, 48 talking therapies, see psychological therapies/ psychotherapies tardive dyskinesia, 162 Tavistock Clinic (London), 37 TCA, see tricyclic antidepressants Teasdale, J., see Abrahamson, L., Seligman, M. & Teasdale, J. temporal organization, 90 temporal plasticity, 90, 98 and distress, 98–100 and sadness and worry, 212 and sexual problems/dysfunction, 232–3 temporal specificity, 90 and distress, 95–8 and sadness and worry, 211–12

and sexual problems/dysfunction, 231–2 testosterone, 231 tetrahydrocannabinol (THC), 86–7, 88 TFP, see transference-focused psychotherapy THC, see tetrahydrocannabinol therapeutic alliance, 136 therapeutic communities for antisocial personality disorder, 337 for borderline personality disorder, 336 therapeutic pessimism, 333 thought disorder, 268 see also schizophrenia Ticehurst House (Sussex), 28, 33 token economy, 42, 254, 278 tonic immobility, 96 training and education by Hearing Voices Network, 154b for psychotherapists, 174 by service user/survivor activists, 145 in social skills for the distressed, 216 transdiagnostic approach to eating disorders and weight concerns, 289, 298, 301–3 transference-focused psychotherapy (TFP), 334 transference theory, 37, 173 transgender, 223, 243 and psychiatric diagnosis issues, 244–5 vs. transsexual, 243 see also gender variance; lesbian, gay, bisexual, transgender, queer and questioning transvestite, 243 trauma and classical conditioning, 207–8 impact on mental health and quality of life, 227b and theory of shattered assumptions, 208 see also childhood abuse and trauma traumagenic neurodevelopmental model of psychosis, 271 treatments/therapies, see interventions tricyclic antidepressants (TCAs), 166, 167, 209, 213 Tuke, W., English businessman and philanthropist, 29 Tupes, E., see Cristal, R. & Tupes, E. Twelve Step programme, 46 twin studies genes and environment, 90 see also concordance (genetics) UFM, see user focused monitoring UKAN, see United Kingdom Advocacy Network unconscious libidinal desires, 37 United Kingdom clinical psychology profession, 254, 339 community care, 46 decline of asylums, 44 de-institutionalization process, 46 hearing voices self-advocacy group, 70b illegal drug classification, 85 Improving Access to Psychological Therapies programme, 174 Managing Dangerous People with Severe Personality Disorder, 337 mental health legislation, 31, 32, 44, 53t, 142, 159, 169, 337

419

migration and development of psychosis, 72–3 prevalence of DSM IV personality disorders, 316t ‘revolving door’ phenomenon, 110–11, 336 service user/survivor movement, 51–2, 143–4, 146–7 Sex Offenders Treatment Programme (SOTP), 240b–1b social inequalities and distress, 133 somatization studies, 71 see also England; National Health Service United Kingdom Advocacy Network (UKAN), 147 United States advocacy of lunacy reforms in mid-19th century, 30 Americans with Disabilities Act, 1990, 51 asylums in 19th century, 30 clinical psychology approach, 254 community psychology, 180 compulsory sterilization laws, 39 decline of asylums, 44 degenerationist theory use, 33, 34b de-institutionalization, 46 dissociative identity disorder, 66, 67–8 Epidemiological Catchment Area (ECA) study, 198 ex-patients movement, 50–1 incidences of somatization, 71–2 increase in number of patients in 19th century, 33 National Comorbidity Study, 204 outpatient commitment/assisted outpatient treatment, 169 prevalence of DSM IV personality disorders, 316t purpose of psychiatric diagnosis in, 113 service user/survivor movement, 50–1, 144 social inequalities and distress, 133 United States Public Health Service, 45 user focused monitoring (UFM), 145 vaginismus, 226 validity of psychiatric diagnosis, 107 of traditional conceptualization of schizophrenia, 259–61 Van Os, J., 261 study on differences in psychiatric diagnosis, 63b Verwoerd, H., prime minster of South Africa, 39 Veterans Administration (US), 42, 45 Viagra, 230, 237 violence and crime and distress association, 170, 255–6 and distress association, media coverage on, 8–9 voice-hearing, 151–2 ‘fox possession’, 61–2 possible coping strategies for, 156b prevalence of, 257 Romme and Escher’s work on, 50, 70b, 152–3 Von Economo, C., encephalitis lethargica, 35–6

PROOF 420 INDEX

Vygotsky, L. on inter-relationship of language development and thought, 93 war and psychotic experiences association, 270–1 Warner, R. on recovery approach, 180, 280 waswas (culture-bound syndrome), 197 Watson, J. B. Behaviorism, 38 little Albert study, 38b weight control behaviours, 284 see also eating disorders and weight concerns weight gain promotion of, 300–1 promotion of, using antipsychotics, 306 WELD and MELD groups, see Women/Men Empowerment Learning Disability groups Wendigo psychosis (culture-bound syndrome), 67b Western culture/societies, 58 attitudes towards body image and eating, 284, 285, 287 differences in psychiatric diagnosis of schizophrenia, 63b individualism in, 59 perspective on biological causation of distress, 76 perspective on psychiatric diagnosis, 108 sadness and worry, 197–200 understanding of self, 60–1 Western psychiatry and psychology

diagnosis of depression, 71 distinction between imagination and reality, 69 emotion and cognition in, 62 view of distress, 57–9 view of somatization, 70 see also German psychiatry White City project (London), 187–8 WHO, see World Health Organization Widiger, T. A. & Mullins-Sweatt, S. N. dimensional approach to personality disorders, 322 Wiggins, J. S., 310 Wilkinson, R. epidemiological research on social inequalities, 132–3, 181–2 Willis, F., physician to King George III, 29 Willis, T. Cerebri Anatome (Anatomy of the Brain), 26 Winwick Hospital, (Warrington, England), 33, 45b Wolpe, J. notion of systematic desensitization, 42 women anxiety disorder diagnosis, 198 cultural ideal of body image, 284, 285, 291–2 eating disorders and control association, 292–3 experiences of sexual problems/ dysfunction, 234b and hysteria, 37 with learning disabilities, 186 mother-daughter relationship and gender transmission, 293–4

psychiatric diagnosis and social judgement of, 109 psychiatric diagnosis and socio-economic status of, 132 and psychiatric diagnosis association, 133 sadness and worry experiences of, 203 ‘schizophrenogenic mothers’/’refrigerator mothers’, 42 White City project, 187–8 see also gender Women at the Margins, 317 Women/Men Empowerment Learning Disability (WELD and MELD) groups, 186–7 World Health Organization (WHO), 47, 200 African mind study, 62 Collaborative Study on Psychological Problems in General Health Care, 62–3 studies on schizophrenia, 64–5 study on social causation of distress, 133 study on somatization, 71 study on women’s health and domestic violence, 203 view of homosexuality, 222 worry, see sadness and worry York Retreat, 29, 30 Zambia professional culture in, 59b zar (culture-bound syndrome), 68 Zeitgeist approach to history, 21b Zubin, J. & Spring, B. stress-vulnerability model of schizophrenia, 262

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