The historical/superstitious model was adopted until the late 17th century, as a result of this model over nine million people died over Europe due to false acquisations of being a witch. The father of medicine Hippocrates believed that hysteria is a problem that only women suffer. He believed that bits of the womans womb would break off and float through the body causing hysteria. The medically acceptable way of treating this was to use devices to smoke or steam out the womb.
The next advancement was during 1733 and 1815 when Franz Mesmer pioneered a therapeutic approach to mental health. His theory was that by getting the mentally ill to hold iron rods in water they would become universally balanced. Shock treatment became a fashion within treatment of the mentally ill and many different therapies were developed. For example in one therapy patients were dipped into hot water then cold water on a continuous circle. However the term mentally ill during this time did not just apply to those who were actually ill, single mothers were classed as mentally ill, as where people who stole in their thrive for survival.
One of the major influences in the development of the mentally ill was brought forward by French neurologist; Jean Martin Charcot (1825 – 1893). He suggested that hypnosis could be used to treat hysteria. Following this the mentally ill began to get treated with more respect and using more humane techniques. From the mid 19th century the asylum population increased to 86,000's and increased further to 120,000's in 1890.The 1930 Mental Treatment Act introduced voluntary and temporary patients. Due to the two world wars patient numbers dramatically increased as many soldiers were admitted due to shell shock and similar disorders.
Many patients died or became worse off due to the mistakes of nursing staff, Montague Lomax's book “The experiences of an asylum doctor” brought light to this fact and pressured legislation. In 1930 the mental health act was developed due to this added pressure and in the 1980's the method of approach became client centred and holistic. Today the holistic model is still used it looks at the treatment of the whole person. This model looks at the biological model and believes that medicine in the best advancement for mental health treatment.
In 1958, Johoda defined mental health as, possessing a set criteria, this mental health criteria includes, the absence of mental health,capability to introspect, being able to self actualise, ability to cope with stress, seeing the world as it really is and the ability to develop and hold relationships with others. It is widely criticised as the absence of mental illness is very subjective, to self actualise is a hypothetical construct and if you are in love, tired, or even had a few alcoholic drinks you will view the world in a different way but it doesn't mean that you are mentally ill.
Different schools of psychology developed different views and treatments to mental health issues, in the late 1800's Freud challenged the medical model with the first school of psychological thought, the psychodynamic model. This model claimed that any abnormal behaviour was due to psychological conflicts that had developed during childhood. It views mental health as being a result of this conflict in early childhood and/or due to unresolved desires and environmental demands. However both models, psychodynamic and medical, both see mental health being a result of underlying causes, which can be diagnosed and treated. Therapies developed from psychodynamic approach are continuing to be practised today, free association, Interpretation of dreams, and play therapy are the most common. Free association was first developed by Freud, who realised if clients were left to talk about anything and everything eventually the unconscious mind would be expressed. This allowed any disorders believed to be created from the unconscious mind to be worked on and hopefully their quality of life could be enhanced, which is why at this time it was known as the “talking cure”. Freud also believed that our dreams are our unconscious thoughts trying to get out into our conscious mind. So during his sessions he asked clients about their dreams and tried to make sense of them. Play therapy has been developed so that children can express their feelings through play. The child would be observed whilst playing to see if there are any signs of distress or any aspects of the child's life that could be considered mentally damaging such as domestic violence. There are many other techniques from other perspectives that are integrated into the individuals treatment along with the psychodynamic techniques.The psychodynamic model is widely criticised as there is no way of measuring these underlying desires and environmental clashes. Due to the faults with this model another two models where developed, the behavioural and the phenomenological model.
The behavioural stance takes a different view as they do not view it as being down to biological factors or unconscious conflicts but learned behaviour. Behaviourists believe that we learn how to act through the interaction with others, so if someone else was to act abnormally then this theory would suggest that we would learn that behaviour from them. As we learn how to act appropriately to societies norms others may learn dysfunctional behaviour in the same way. This theory stemmed the basis for the cognitive-behavioural model. This model believes that someones disorder may not only stem from an environmental issue, such as a family death, but from self feelings and emotions, their emotional state at that time will affect their mental health.
The third major school is the humanistic school where the phenomenological model is derived from. The way in which the person views the world affects the way in which they act. This perspective believes that everyone has the ability to reach their full potential and self actualise. It is when someones self actualisation route is blocked that abnormal and mental illness may occur. The individual will begin to distort their view of the world and their reality will become dysfunctional. The higher the level of distorted reality and the lower the level of the individuals ability to connect with their own feelings the more serious the individuals condition is. Like the behaviourist views abnormal behaviour is said to be a reaction to the way the individual perceives the world. The phenomenological model is highly criticised as being to simplistic as it assumes that anyone who perceives the world in a negative light is mentally unhealthy but it may be the case that their life at that time isn't the most desirable. The phenomenological model also does not believe in mental health it doesn't exist it, it is just a distraction that some people gain on their way to actualisation.
Today the medical/biological model is used at present time, this consists of the three models psychodynamic, behaviourist, and the phenomenological (or humanistic) all merged together. The linking of all three models together has led to the development of the diathesis-stress model which connects the physical, environmental and psychological aspects to the cause of mental illnesses.
Schizophrenia is a disorder where the individuals thought processes, perceptions, emotions and behaviour are all disturbed. It is usually recognised from the age 14 to early 20's, there are some records of 4 year olds however it is extremely rare. Due to the hormone changes and puberty it is very difficult to notice as it is often regarded as being typical teenage angst. Schizophrenia carries a strong stigma that is probably due to the film industry for portraying them as being raving psychotic murderers, however this is exremely rare. Schizophrenia was first recognised by Emil Kraepelin (1896) he called it dementia praecox, he believed it to be a result of deterioration of the mental state in adolescence. Bleuler first used the term schizophrenia in 1911, he believed that it was a state when the “personality loses its unity”. Like Kraepelin he noticed that there was a sign of mental deterioration within the case of schizophrenia however he did also note that this deterioration didn't continue to deteriorate it stabalises.
A person has to show specific characteristics, known as schneider's first rank symptoms (1959), to be diagnosed as schizophrenic. The individual may show significant changes in their perception of reality, they will believe thoughts are bing put in their head, they begin to hallucinate often auditory, and show signs of primary delusion, holding false beliefs even when there is clear contradictory evidence.
There are many different types of schizophrenia, Simple, Hebephrenic, Catatonic and Paranoid. Simple schizophrenia is a slow gradual change the individual experiences they becomes more and more withdrawn and often cannot form relationships easily if at all. However this type of schizophrenia does not show any signs of psychosis unlike all other types. In the case of hebephrenic schizophrenia the individual confuses moods and emotions, they will show wrong type of emotion or words under certain circumstances they may laugh at the news of a death for example. Catatonic schizophrenia is different from the rest as it involves the individual to experience psychomotor disturbances, these may include hyperkinesis (hyperactivity), or they may do the exact opposite of what they are asked to do, and they may appear to stop completely and hold the exact same position for hours or even days. Individuals who are diagnosed as a paranoid schizophrenic are often, as the name suggests, suffering from hallucinations that have left them in an untrustworthy paranoid state.
There are two known symptom categories, the positive and the negative symptoms. If experiencing positive symptoms the individual may be experiencing hallucinations which could be auditory which is the most common (hearing voices), visual (visual perception distorted) or/and tactile (feeling of being touched). They may also be delusional, they may gain false beliefs that are not rational and keeping with the persons previous beliefs. For example they may believe they are someone else, or that someone is putting thoughts in their head. They may also develop a thought disorder, where they may, produce a word salad (a gathering of words not actually forming a sentence), move from one chain of thought to another with no apparent link, or make up entirely new words, neologisms. Negative symptoms however, include a gradual lack of motivation which is usually coupled with social withdrawal. The persons hygiene and social skills also tend to deteriorate.
The cause of schizophrenia is still unknown til this day, we do know that some factors play a part but we dont understand the full cause. Iverson (1979), believed in a biological cause of schizophrenia, he believed that there is a connection with dopamine and schizophrenia. Schizophrenics produce to much dopamine which Iverson believes to be the cause of their abnormal behaviours, thoughts and feelings. A type of drug known as neuroleptic is prescribed to schizophrenics to reduce the production rate of dopamine such drugs may include, largactil, stelazine and modecate. Such drugs can only regulate the amount of dopamine produced they cannot get rid of the reason why so much dopamine was being produced in the first place. The side effects of the drugs can often be worse than the original symptoms. Gottesman (1991) found that people who are related to someone with schizophrenia are ten times more likely to develop it than people who don't have it in their family. This clearly suggests that schizophrenia is a natural occurance and is carried in our genes. There is argumentatively a substantial amount of genetic elements in many illnesses. Monozygotic (identical) twins have been and remain to be used within the continuing nature nurture debate. A variety of studies have been conducted in order to show if there is an genetic factor causing mental illness to arise.
Within the study of Schizophrenia Gottesman found that only in 44% of the cases studied did both monozygotic twins develop schizophrenia. Identical twins are genetically identical so if mental illness was an entirely innate genetic factor then both twins would develop the disorder, so what is protecting the other 56% of cases. In non-identical twins both twins had it in only 12% and in siblings it occurred only 7%. One problem with nature nurture studies is that they emphasise the importance of genetics but they do so using families however families usually live together so they would share the same environment.
From the behaviourist perspective skinner would argue that children learn their behaviours from their environment. So if a relative is schizophrenic then chances are the child would imitate their behaviours and learn them. Although it is argued that you can only imitate the external aspects of schizophrenia you cant imitate the internal hallucinations. Other disorders such as obsessive compulsive disorder however could be entirely environmental as it could be a learned routine. Psychodynamic approach also believes that schizophrenia is gathered through the environment. The child will be brought up with the ideas that the schizophrenic model's ideas are socially normal and will adopt them as their own, the child will acquire the schizophrenic emotions.
Payne (1959) held a cognitive stance he believed that schizophrenics have limited cognitive abilities in filtering out the non-important information so they possessed all sensory data with relevant or not leading them to a life of conflicting knowledge leaving them utterly confused. From the humanistic stance Thomas Szasz (1972), presented an alternative theory, different from all the rest. In his book “The myth of mental illness” he claimed that mental illness is just an alternate way to perceive the world. Laing also followed this idea but took it further to say that mental illness is nothing more than a label that we place on those who view the world differently to ourselves. He claimed that those who we consider mentally ill may actually be viewing the real world and the “sane” individuals are actually the ones who are viewing a distorted world.
The biological explanation looks at the genetic and physical side of mental illness. In 1982 Andreasen found that schizophrenics generally have enlarged ventricles in comparison to those who are mentally healthy. Dopamine, the neurotransmitter brain chemical is produced excessively within those who are schizophrenic according to Seidman in 1990. In 1988, Richard Bentall took all the previous research, collated it and concluded that there is no significant cause of schizophrenia and that it was actually found to be conflictorary and deceptive. He declared that schizophrenics are all individual and different they don't share the same symptoms or causes. He states that “ schizophrenia is a disease with no particular symptoms, which follows no particular course, has no particular outcome, and responds to no particular treatment, it is unsurprising that research reveals it to have no particular cause.”
The medical (biological) model is the most desirable model today, it uses a range of treatments the most common being electro convulsive therapy (E.C.T), psychosurgery and drugs/medication. E.C.T was highly favoured in the 1940's and the 1950's, today approximately 20,000 people a year get treated with E.C.T in the United Kingdom. It is used mainly to treat the extremely depressed people who haven't benefited from medication. This treatment involves 70 to 140 volts are passed through the body which left the individual unconscious, loss of memory, brain damage, learning difficulties and in extreme cases death.
In 1935 Moniz carried out the very first pre-frontal lobotomy, this involves an incision into the patients tissue that connects the frontal lobes with the sub cortical brain areas. This method holds many side effects and is used mainly with depressed and schizophrenic patients. By using this therapy patients are faced with a number of consequences as there are numerous side effects to the surgery. They may suffer from emotional blunting, severe intellectual impairment, epilepsy, personality changes and in some cases can unfortunately result in death therefore thos treatment is used only in last chance scenarios.
Medications/Drugs are the most popular method today, drug treatments fall into four catagories Anti psychotics, Anti depressants, Lithium and Anxiolytics. Anti psychotics have been used to reduce psychotic symptoms and has a statistical success of 60–80%. Anxiolytic drugs are anti anxiety drugs which are highly effective, but patients tend to become reliant on the drugs and if taken unresponsibly can be fatal (especially if taken with alcohol or if the overdose).
When considering schizophrenia the medical model presents the most relaible explantion for the disorder. Two brain malfunctions have been highlighted by the medical model, faulty neurotransmitters (dopamine) and abnormalities in the size and structure of the brain. Twins studies were previously the main key to investigating the cause of schizophrenia however with advancements in technology and from the use of molecular screening genes have been identified as a cause. In 1999, the Human Genome Project identified genes on chromosome 22 which is present in individuals suffering from the disorder. This claims that people born with this difference on chromosome 22 will have a predistribution to develop schizophrenia. Contradictory to this is Gottesman's evidence that suggests that it is not entirely derived from genetics, the environment must play a part too.
In 1983, Kety found more evidence on biological side, by studying adopted children whos adopted parents were suffering from schizophrenia, his results suggest that it is a heredictory disorder as adopted children did not develop the disorder, however it is not clearly explained as to what is being inherited. According to the biological approach an abnormal excess amount of dopamine is a cause of schizophrenia, Snyder,1976. Davis (1974) investigated the effects of injecting schizophrenics with dopamine and results concluded that mild schizophrenics became worse and depending on dosage some became extreme schizophrenic behaviour within minutes. Phenothiazine studies have given their added support to Snyder's dopamine hypothesis as they have shown that schizophrenic symptoms are reduced when D2 receptors (dopamine receptors) are blocked.
PET scans show that schizophrenics have enlarged ventricles, a reduced blood flow, underdeveloped brain tissue and an increased matabolic activity of the brain. Crow (1985) stated his belief that schizophrenia is built up of two causes, in his two-syndrome hypothesis. The first being the distorted neurotransmitters (dopamine) this results in the individual experincing positive symptoms and the second type being cerebral damages this resulting in negative symptoms.
Nurture nature debate is extremely complex and within mental illness it is hard to conclude which holds more evidence. It is clear that over the years the beliefs and accepted causes of mental health have changed dramatically. Within the example of schizophrenia it is clearly evident how complicated the nature nurture debate is. As evidence from Gottesman clearly contradicts any arguements for nature arguement however Davis's dopamine hypothesis is a clear nature explanation rejecting nurture explanations. Now we can tell nature and nurture both play a part in mental illness, although some may be more one than the other, Schizophrenia however is clear to have aspects of both.
