Further Therapies:
Other therapies used by the psychodynamic model include the famous Rorschach inkblot test. Developed by Hermann Rorschach in 1918, after noticing that patients diagnosed with schizophrenia made radically different associations to the Klecksographie inkblots than normal people. He developed the Rorschach test as a diagnostic tool for schizophrenia. The Rorschach test involves looking at a set of cards containing pictures of inkblots that have been folded over on themselves to create a mirror image. The test is what psychologists call a projective test with the idea that when a person is shown an ambiguous or meaningless image i.e. the inkblot, the unconscious mind will work hard at imposing meaning on the image. By asking the person to tell you what they see in the inkblot, they are actually telling you about themselves, and how they project meaning on to the real world. However the Rorschach inkblot test has been criticised by some psychologists who have argued that the testing psychologist also projects his or her unconscious world on to the inkblots when interpreting responses. For example, if the person being tested sees a bra, a male psychologist might classify this as a sexual response, whereas a female psychologist may classify it as clothing. It has also been criticised for its validity, is it measuring what it says it is measuring? Rorschach was clear that his test measured disordered thinking as found in schizophrenia and this has never been disputed. But whether it accurately measures personality as well is up for debate. Finally, critics have suggested that the Rorschach lacks reliability as two different testers might come up with two different personality profiles for the same person. The controversy about its reliability and validity has been present since its conception. Today most psychologists in the UK think the Rorschach inkblot test is nonsense.
Another therapy is Gestalt Therapy, which focuses on the whole of an individual's experience, their thoughts, feelings and actions and concentrates on the 'here and now' or simply what is happening from one moment to the next. Roughly translated from German, Gestalt means 'whole' and was developed in the 1940's by Fritz Perls. The main idea of this approach is for the individual to become more self-aware, taking into account their mind, body and soul.
A therapist will constantly promote the client's awareness of themselves and often uses experiments that are created by the therapist and client. These experiments can be anything from creating patterns with objects and writing to role-playing. Promoting self-awareness is the main objective of gestalt therapy but other areas such as improving the ability to support ones emotional feelings are also important. Gestalt therapy is influenced by psychoanalytic theory and therapists will concentrate on 'here and now' experiences to remove obstacles created by past experiences.
Strengths of the Psychodynamic approach:
One of the major strengths of the approach is the fact that it tries to get to the root cause of the problems faced by patients unlike the biological and behaviourist model where the symptoms of the patient are treated rather than the actual cause, the psychodynamic approach reflects the complexity of human behaviour. It has been very useful in highlighting the fact childhood is a critical period in development as who we are and become is greatly affected by our childhood experiences. Ideas put forward by Freud have greatly influenced the therapies used in treating mental illness, Freud was the first to recognise that psychological factors could be used to explain physical symptoms such as paralysis. Psychoanalysis has been widely used to help people overcome psychological problems. Another strength of the psychoanalysis is that it uses case studies as its methodology. Freud conducted clinical interviews with his patients, listening to his patients and exploring their problems allowed him to develop his theories of human behaviour. The study of Little Hans helped develop his theory of the ‘Oedipus Complex’. Another advantage of case studies is that highly detailed and in depth data is provided which other models tend to neglect, such as feelings, emotions and personal experiences.
There is evidence that treatment is effective, Bergin (1971) in a huge study of 10,000 patients found that 80% of patients found the treatment beneficial compared with 65% from therapies based on a number of different approaches. Tschuschke et al (2007) reported that the longer treatment lasts the more effective it will be. Others support the idea of early experiences effecting later psychological health, Kindler et al (1996) found that twins separated from a parent in early life were more prone to depression and to alcoholism later in life. Comer (2001) reported a link between childhood trauma and adult psychological disorders but to nothing like the extent that Freud would have predicted.
The fact that psychoanalysis is used today, even in the NHS proves that it is effective for some patients. Studies such as the one by Brown & Harris (1978) concluded there was a link between life events and the onset of depression, the study found children who had lost their mother, especially girls were vulnerable to depression. The study supports Freud’s idea that depression in adults is linked to loss in childhood.
Weaknesses of the Psychodynamic approach:
The model is subjective and lacks any sort of scientific validity as Freud’s theory was developed from his own interpretations of his patient’s thoughts and cannot be verified using objective or scientific research. The methods used by the psychodynamic are especially questionable as most ideas are based on case studies which as we’ve already seen provide lots of detailed information about a case but are particularly difficult to generalise and in some cases impossible to prove or disprove. In interpreting dreams, if the patient agreed with Freud’s interpretation this would be seen as supporting evidence. If the patient did not agree then Freud saw this as the patient’s denial or inability to come to terms with the nature of their repressed thoughts. Similarly if a patient behaves as expected this would be seen as support, if they behaved differently this would be proof of the existence of defence mechanisms. Freud places too great an emphasis on childhood experiences whilst ignoring more recent adult events and similarly, according to later psychodynamic theorists places too great an emphasis on sex. Erik Erikson (1963) describes psychosocial stages of development rather than psychosexual and believes that emotional conflict can arise from adult events just as much as childhood events. The components of personality, the stages, libido Eros and Thanatos are all hypothetical constructs, impossible to define or to study objectively and only manifest themselves through a subjective analysis of a patient.
A major criticism of Freud’s theory is that it is difficult to falsify, where as a good theory is one that can be tested to see if it is wrong. Popper (1935) argued that falsification is the only way to be certain, in other words, you can’t prove that a theory is right you can only falsify a theory. Many of Freud’s predictions are questionable, an example of this was his view that all men have repressed homosexual tendencies cannot be disproved, but if you do find men who have no repressed homosexual tendencies then it could be argued that they have them as they are so repressed they are not apparent. In other words, the prediction cannot be falsified. However, while it is difficult to generate testable hypotheses from Freud’s theory of personality, it is not impossible. For example, research has looked at the relationship between guilt and wrongdoing Freud predicted an inverse relationship, and MacKinnon (1938) did find that individuals who cheated at a task tended to express less guilt when questioned about life in general than those who did not cheat. Another criticism of the theory is False Memory Syndrome where patients undergoing therapy have supposedly recalled long lost traumatic memories from childhood. Many of these have involved abuse by a parent, relative or friend. Psychoanalysis assumes that childhood memories can be recalled in this way and actively encourages this in order to access the unconscious mind. In fact there is little evidence to suggest that childhood memories can be accessed in this way leading some to suggest that memories have been inadvertently implanted by the therapy. In 1986, Nadean Cool a nursing assistant in Wisconsin, sought therapy from a psychiatrist to help her cope with her reaction to a traumatic event experienced by her daughter. The psychiatrist used hypnosis and other suggestive techniques to uncover buried memories of abuse that Cool herself had experienced, Cool became convinced that she had repressed memories of having been in a satanic cult, eating babies, being raped, having sex with animals and being forced to watch murder of her 8-year-old friend. Cool came to believe that she had more than 120 alter personalities. Cool eventually came to believe that false memories had been implanted and sued the therapist for malpractice, in March 1997 after 5 weeks of trial, her case was settled for $2.4 million.
Other major critic’s of Psychoanalysis were Hans Eysenck and philosopher Karl Popper who both challenged the notion that psychoanalysis meets the criteria of a science. Popper argued that for Freudian theory to qualify as a science, it should be accessible to tests made by others. Science cannot be based on belief or personal philosophy, but must be based on evidence that others can attempt to disprove. Popper believed that the predictions made by psychoanalysis are not predictions of obvious behaviour but of unseen psychological states. This reference to hidden states makes them untestable, to Popper’s way of thinking. For example, Popper suggested that only when some individuals are not neurotic is it possible to experimentally determine if prospective patients are currently neurotic. He pointed out that because psychoanalysis holds that every individual is neurotic to some degree, it is impossible to design an experiment that would demonstrate the contrast between neurotic and non-neurotic people. Eysenck (1986), who conducted the first study of the effectiveness of psychotherapy, challenged the legitimacy of psychoanalysis based on his conclusion that it is ineffective:
“I have always taken it for granted that the obvious failure of Freudian therapy to significantly improve on spontaneous remission or placebo treatment is the clearest proof we have of the inadequacy of Freudian theory, closely followed by the success of alternative methods of treatment, such as behaviour therapy”.
Eysenck himself has been criticised for his methods, but concluded that psychoanalysis was like giving a patient a placebo.
The Behavioural approach:
The behaviourist approach dominated psychology in the first half of this century, especially in the United States. The goals of behaviourism were to move psychology toward a scientific model, which focused on the observation and measurement of behaviour. Its assumptions were that behaviour is primarily the result of the environment rather than genetics or instincts and so behaviourists reject the view that abnormal behaviour has a biological basis. Like the psychodynamic theorists, behaviourists have a deterministic view of mental disorders believing that our actions are largely determined by our experiences in life. However, unlike Freud they see abnormal behaviour is a learned response (through conditioning) and not as the result of mysterious and they would argue unknowable unconscious processes. While much of our behaviour is adaptive, helping us to cope with a changing world, it is also possible to learn behaviours that are abnormal and undesirable. However, such maladaptive learning can be treated by changing the environment so that un-learning could take place.
Behaviour therapies:
These are often used to treat phobias and involve the patient learning to associate their phobic stimulus spider or whatever with relaxation. Systematic desensitisation was created by Joseph Wolpe and is seen as a pleasant way of helping a patient, other therapies from this model include aversion therapy, flooding and Eye Movement Desensitization and Reprocessing
Systematic desensitization:
Involves a series of steps, which occur over several therapy sessions:
- The therapist and client make up an anxiety hierarchy, the hierarchy lists stimuli that the client is likely to find frightening. The client ranks the stimuli from least frightening to most frightening.
- The therapist teaches the client how to progressively and completely relax his body.
- Next, the therapist asks the client to first relax and then imagine encountering the stimuli listed in the anxiety hierarchy, beginning with the least-frightening stimulus. If the client feels anxious while imagining a stimulus, he is asked to stop imagining the stimulus and focus on relaxing. After some time, the client becomes able to imagine all the stimuli on the hierarchy without anxiety.
- Finally, the client practices encountering the real stimuli.
When they feel comfortable with this they move on. The role of the analyst is also important since they need to recognise the reason for the fear. Sometimes this may be irrational but there may also be logical reasons for the fear which need to be dealt with too. Systematic desensitisation is an effective therapy with patients showing much greater recovery than with no therapy, based on a scientifically tested theory it has formed the basis of later behaviourist therapies such as exposure therapy (flooding). Whilst systematic desensitisation is a slow process, research suggests that the longer the technique takes the more effective it is. It has also been shown to have long term benefits. However, systematic desensitisation is limited in use, being used mostly to treat specific anxiety disorders such as phobias. Irrational fears of spiders, buttons etc are seen as relatively trivial disorders in comparison to schizophrenia or bipolar disorder where it has little or nothing to offer. The behaviourist approach does struggle with more serious disorders such as the initial symptoms of schizophrenia which include hallucinations and delusions are internal mental states which the behaviourists ignore in an attempt to create a scientifically testable theory.
Aversion therapy:
Aversion therapy uses the behavioural approach principles that new behaviour can be 'learnt' in order to overcome addictions, obsessions and violent behaviour. Patients undergoing aversion therapy are made to think of the undesirable experience that they enjoy, for example a violent person might be shown images of violent crime, or an alcoholic might be made to drink, while drugs or electric shocks are administered. In theory the patient will over time come to associate their addiction with the negativity of electric shocks or seizures and has been used to treat a host of undesirable behaviours such as smoking, alcoholism, gambling, violence and homosexuality when it was considered a mental illness.
Aversion therapy's long term success in treating patients is questionable as patients may appear to be treated by therapy but once out of the view of doctors, where the deterrent drugs or electric shocks are removed, they may feel able to return to their addictions or undesirable behaviour. Aversion therapy has endured much criticism in previous decades in its use in abusing patients. At a time when homosexuality was considered by some to be a mental illness, gay people were made to undergo aversion therapy for their lifestyles which included receiving electrical shocks if they became aroused by specific stimuli. A number of fatalities have also occurred during aversion therapy.
Token Economies:
A token economy is a behaviour modification program based on operant conditioning principles. Token economies are sometimes successfully used in institutional settings, such as schools and psychiatric hospitals. People receive tokens for desirable behaviours such as getting out of bed, washing and cooperating. These tokens can be exchanged for rewards such as going for leave on hospital grounds, TV-watching time or exchange in the hospital shop for cigarettes or snacks. In a study carried out by Burchard and Barrera (1972) using a token economy system designed for the rehabilitation of mildly mentally ill young boys who displayed a high frequency of anti-social behaviour. Tokens were mostly earned through achievement in the workshop and were exchanged for a variety of rewards, such as meals, recreational trips, clothes or purchases. A time-out procedure was also adopted where boys had to sit on a bench behind a partition, hence having time out from being able to receive reinforcers; also a response cost procedure was employed during which reinforcers were removed, thus tokens were removed. Time out and deprivation of tokens occurred following swearing, personal assault, property damage or other undesirable behaviour, it was found that these things repressed the boy's bad behaviour, but in some boys one technique might be more effective than another. Behaviour modification is being applied to a whole variety of what are traditionally considered disturbed behaviours with good results. The main practical difficulties are being able to find suitable reinforcers and to apply the techniques constantly. Some critics have suggested that behaviour modification may succeed in changing behaviours but not the processes that underlie them, and also that it could be used to teach that behaviour which best fits the demands of the institution rather than that which is in the individual's best interest. Using a Token economy system within an institution presents many difficulties, as staff have to ensure that reinforcement and removal of tokens must be consistent and done constantly. All staff, be it day or night have to be fully involved, they also have to carry out their roles fully for such a programme to work. It only requires one staff member to fail at their task for the effectiveness of the programme to fail. Organising and carrying out such a scheme requires time and effective planning, it is an expensive and time consuming way to change behaviour, if some staff are not committed to the programme then it is likely fail. There is also no attempt to address the cause behind why the children are trouble makers, and what might be a more dignified way of helping them. Who decides what is or is not acceptable behaviour, the staff within the institution not the individual children themselves. Such a scheme could be open to unlimited abuse. It is no coincidence that in some closed environments of hospitals and homes some staff members have been caught physically and mentally abusing defenceless people, a perfect example is that of Winterbourne hospital run by the Castlebeck group which featured on BBC’s Panorama programme 31 May 2011 (http://www.bbc.co.uk/news/uk-20070437) a reporter went undercover and filmed shocking abuse carried out on the residents of the home. Following the investigation a number of staff have been charged and arrested for the abuse of vulnerable clients whilst in their care.
Eye Movement Desensitization and Reprocessing:
A fairly new therapy is Eye movement desensitization and reprocessing (EMDR), developed by Francine Shapiro in 1987, is a method that some therapists use to treat problems such as post traumatic stress disorder, panic attacks and more recently phobia’s. This treatment is a type of exposure therapy in which clients move their eyes back and forth while recalling memories that are to be desensitized. Many critics of EMDR claim that the treatment is no different from a standard exposure treatment and that the eye movements do not add to the effectiveness of the procedure. The treatment is fairly complex and includes elements from several different schools of therapy. The most unusual part of the treatment involves the therapist waving his or her fingers back and forth in front of the client's eyes, and the client tracking the movements while focusing on a traumatic event. The act of tracking while concentrating seems to allow a different level of processing to occur. The client is often able to review the event more calmly or more completely than before.
Strengths of the Behaviour Approach:
The major strength of the behavioural approach is that some disorders especially phobias do seem to be a result of ‘faulty learning’. The behavioural approach is better than the biological approach at explaining some disorders such as Post-Traumatic Stress Disorder, which is an anxiety disorder that occurs in response to an extreme psychological or physical experience. At least some sufferers show anxiety reactions to stimuli which were present at the time of the trauma. A main strength of the behaviourist perspective has been the development of useful applications. One strength of the behaviourist approach is that it has successfully applied classical and operant conditioning to its theories. Systematic desensitisation is based on classical conditioning and is useful for treating phobias. Another strength of the behaviourist approach is that it uses scientific methods of research, which are objective, measurable and observable, such as Bandura's bobo doll study of aggression. The behavioural approach offers very practical ways of changing behaviour from for example therapies through to advertising. However at the same time this does raise an ethical issue as if the behaviourist perspective is able to control behaviour who decides which behaviour should be controlled or changed.
Weaknesses of the Behaviour Approach:
The behaviourist approach to understanding abnormality is very reductionist as it reduces explanations for behaviour to simple reward and punishment. While some behaviour’s such as the acquisition of phobias, may be explained this way, there are many abnormal behaviours that seem to be passed on genetically, for example alcoholism, autism and schizophrenia and so it is difficult to explain them solely in terms of classical or operant conditioning. Similarly there are many disorders, for example depression, that seem to feature abnormal levels of neurotransmitters and so a biological explanation may be more sensible than a simple behaviourist one. Behaviourism can explain the role of the media in the acquisition of certain abnormal behaviours. Anorexia has long been linked with the 'perfect' body image as portrayed in the media. People may learn to be anorexic through social learning by observing models and actresses, reading about the diets they are on, and copying the behaviour they see. The majority of research into classical and operant conditioning has been conducted on animals. Aside from the possible ethical implications of animal research, there is also the issue of generalising findings from one species and applying them to another. Assumptions have to be made that at least some human physiology and psychology is the same as animal physiology and psychology, but clearly humans are different to animals. The behaviourist approach is extremely determinist because it states that a behaviour that has been reinforced will be carried out, and one that has been punished will not be carried out. However, humans clearly have a degree of free will and are able to decide when to carry out some behaviours and when to resist them. Cognitive theories of behaviour try to account for free will and decision making, and so it may be better to combine behaviourist and cognitive approaches when trying to explain abnormal behaviour. A further problem with the behavioural perspective is that many of the practical uses of the approach such as aversion therapy and token economy systems when used as a way of changing behaviour do tend to be short lived. That is, they do change behaviour but often only for a limited time. The behaviourist model also struggles to explain why we acquire phobias for some objects or events quicker than others. In a modern world, fast cars, wintery conditions and using a mobile whilst crossing the road are far more threatening than spiders and snakes but we don’t develop car phobia.
The Biological Model:
The biological model aims to explain all behaviour and experience in terms of physical bodily processes. For example, when you feel stressed this usually involves a sensation of your heart pounding, your palms being sweaty and so on. These are physical symptoms created by activation of the nervous system. Your experience of stress is caused by the biological processes involved. The nervous system is divided into the central nervous system (CNS) and the autonomic nervous system (ANS), which is further subdivided into the sympathetic and parasympathetic branches. The central nervous system comprises the brain and spinal cord, containing about 12 billion nerve cells or neurons.
It explains behaviour in terms of the following assumptions:
- Different areas of the brain are specialised for certain functions, the cerebral cortex covers the surface of the brain and is responsible for higher cognitive functions. The cerebral cortex is divided into four lobes with the most important being the frontal cortex or lobe, responsible for fine motor movement and thinking. Other lobes include the occipital lobe, which is associated with vision. Underneath the cortex there are various sub cortical structures such as the hypothalamus which integrates the autonomic nervous system and plays a part in stress and emotion.
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Neurons are electrically excitable cells that form the basis of the nervous system. The flexibility of the nervous system is enhanced by having many branches at the end of each neuron called dendrites, so that each neuron connects with many others. One neuron communicates with another neuron at a synapse, where the message is relayed by chemical messengers or neurotransmitters. These neurotransmitters are released from presynaptic vesicles in one neuron, and will either stimulate or inhibit receptors in the other neuron. The synaptic cleft or gap is about 20 nanometres wide. Some common neurotransmitters are dopamine which is associated with rewards and also schizophrenia, serotonin associated with sleep and arousal, adrenaline associated arousal and (GABA) which decreases anxiety.
- Hormones are biochemical substances that are produced in one part of the body (endocrine glands such as the pituitary and adrenal glands) and circulate in the blood, having an effect on target organ(s). They are produced in large quantities but disappear very quickly. Their effects are slow in comparison with the nervous system, but very powerful. Examples of hormones include testosterone (a male hormone) and oestrogen (female hormone). Some hormones such as adrenaline are also neurotransmitters.
The biological approach has become the most widely used form of treating mental illness since the 1960’s. The biological model takes the same approach as it does for physical ailments, and assumes that psychological problems have a physical cause such as genetics where the patient may have inherited the illness from his parents or run in the family, possibly through a rouge or bad gene. The model takes the approach as with other illnesses that physical intervention will be required be it chemotherapy (drug therapy), ECT (electroconvulsive therapy) and previously surgery to treat psychological issues. Although the biological model focuses on internal, biological processes, it does not ignore the possibility that the environment can have a role to play in abnormality.
Biological Therapies:
Biomedical therapies include chemotherapy (drug therapy), electroconvulsive therapy (ECT) and psychosurgery.
Chemotherapy (drug treatment):
The most widely used form of treatment available under biological therapies is chemotherapy (drugs) with almost 25% of NHS prescriptions being for drugs to treat mental disorders in the United Kingdom. It aims to treat psychological disorders with medications and is usually combined with other kinds of psychotherapy. The main categories of drugs used to treat psychological disorders are antianxiety drugs, antidepressants, and antipsychotics.
Antianxiety Drugs:
Antianxiety drugs include a class of drugs called benzodiazepines, or tranquilizers. Two commonly used benzodiazepines are known by the brand names Valium and Xanax. The generic names of these drugs are diazepam and alprazolam, respectively. Benzodiazepines reduce the activity of the central nervous system by increasing the activity of GABA, the main inhibitory neurotransmitter in the brain. Benzodiazepines take effect almost immediately after they are administered, however their effects last just a few hours. Psychiatrists usually prescribe these drugs for panic disorders and anxiety. Benzodiazepines do have side effects which may include drowsiness, light-headedness, dry mouth, depression, nausea and vomiting, constipation, insomnia, confusion, diarrhoea, palpitations, nasal congestion, and blurred vision. Benzodiazepines may also cause drug dependence in some patients who seem to get a buzz whilst on them. Tolerance can occur if a person takes these drugs for a long time, and withdrawal symptoms often appear when the drug use is discontinued.
Antidepressant Drugs:
Anti-depressants usually take a few weeks to have an effect and divided into three classes the first being Monoamine oxidase inhibitors (MAOIs) which include phenelzine (Nardil), the second are Tricyclics which include amitriptyline (Elavil) and have generally have fewer side effects than the monoamine oxidase inhibitors and the third class are Selective serotonin reuptake inhibitors (SSRIs) which are the newest class of antidepressants, include paroxetine (Paxil), fluoxetine (Prozac), and sertraline (Zoloft).
Antidepressants are typically prescribed for depression, anxiety, phobias and obsessive-compulsive disorders. Monoamine oxidase inhibitors and Tricyclics increase the level of the neurotransmitters norepinephrine and serotonin in the brain whilst Selective serotonin reuptake inhibitors increase the level of serotonin only. Whilst antidepressants are not addictive, they often have side effects such as headache, dry mouth, constipation, nausea, weight gain, and feelings of restlessness. Of the three classes of antidepressants, MAOIs generally have the most side effects, many people who take MAOIs also have to restrict their diet, because MAOIs interact negatively with foods that contain the amino acid tyramine, such as beer and some cheeses and meats. SSRIs have fewer side effects than the other two classes of antidepressants. However, SSRIs can cause sexual dysfunction and if they are discontinued abruptly, withdrawal symptoms occur.
Antipsychotic Drugs:
Antipsychotic drugs are mainly used to treat mental health conditions such as schizophrenia and other psychoses, agitation, severe anxiety, mania and violent or dangerously impulsive behaviour. They include chlorpromazine (Thorazine), thioridazine (Mellaril) and haloperidol (Haldol) and usually begin to take effect a few days after they are administered. Antipsychotic drugs reduce sensitivity to irrelevant stimuli by limiting the activity of the neurotransmitter dopamine. Many antipsychotic drugs are most useful for treating positive symptoms of schizophrenia, such as hallucinations and delusions. However, a new class of antipsychotic drugs, called atypical antipsychotic drugs also help treat the negative symptoms of schizophrenia. They reduce the activity of both dopamine and serotonin. Atypical antipsychotic drugs include clozapine (Clozaril), olanzapine (Zyprexa), and quetiapine (Seroquel). Atypical antipsychotic drugs can sometimes be effective for schizophrenia patients who have not responded to the older antipsychotic drugs, however side effects include drowsiness, constipation, dry mouth, tremors, muscle rigidity and coordination problems. These side effects often make people stop taking the medications and this frequently results in a relapse of schizophrenia. A more serious side effect is tardive dyskinesia, a usually permanent neurological condition characterized by involuntary movements. To avoid tardive dyskinesia the dosage of antipsychotics has to be carefully monitored. The atypical antipsychotics have fewer side effects than the older antipsychotic drugs and are less likely to cause tardive dyskinesia. In addition, relapse rates are lower if people continue to take the drug. However, the relapse rate is higher with these drugs if people discontinue the drug as they assume they are now well and therefore do not need to take them.
Lithium:
One drug used in the treatment of bipolar disorders is lithium, it prevents mood swings in people with bipolar disorders. Researchers have suggested that lithium may affect the action of norepinephrine or glutamate. As with all drugs there are side effects, lithium can cause tremors or long-term kidney damage in some people. Doctors must carefully monitor the level of lithium in a patient’s blood. A level that is too low is ineffective, and a level that is too high can be toxic. Discontinuing lithium treatment abruptly can increase the risk of relapse. Recently developed alternatives to lithium include the drugs carbamazepine (Tegretol) and divalproex (Depakote).
Electroconvulsive Therapy (ECT):
ECT is a treatment for a small number of severe mental illnesses. It was originally developed in the 1930s and was used widely during the 1950s and 1960s for a variety of conditions. It is now clear that ECT should only be used in a smaller number of more serious conditions. ECT consists of passing an electrical current through the brain to produce an epileptic fit – hence the name, electro-convulsive. The idea developed from the observation that, in the days before there was any kind of effective medication, some people with depression or schizophrenia, and who also had epilepsy, seemed to feel better after having a fit. Research suggests that the effect is due to the fit rather than the electrical current. Electrodes are placed on the patient’s head over the temporal lobes of the brain. Anaesthetics and muscle relaxants help minimize discomfort to the patient, while an electric current is delivered for about one second. The patient has a convulsive seizure and becomes unconscious, awakening after about an hour. The typical number of ECT sessions varies from six to twenty, and they are usually done while a patient is hospitalized. The National Institute of Health and Clinical Excellence (NICE) have looked in detail at the use of ECT and have recommended that it should be used only in depression, resistant mania or catatonia. They say ECT should be considered for acute treatment of severe depression that is life threatening and when a rapid response is required, or when other treatments have failed. It should not be used routinely in moderate depression, but should be considered for people with moderate depression if their depression has not responded to multiple drug treatments and psychological treatment.
Psychosurgery:
As a last resort when drugs and ECT have failed psychosurgery is an option, it basically involves either cutting out brain nerve fibres or burning parts of the nerves that are thought to be involved in the disorder while the patient is conscious. The most common form of psychosurgery is a prefrontal lobotomy. Unfortunately these operations have a nasty tendency to leave the patient vegetablised or ‘numb’ with a flat personality, shuffling movements etc. due to their inaccuracy. António Egas Moniz discovered the lobotomy in 1935 after successfully snatching out bits of chimpanzee’s brains. It didn’t take long for him to get the message that his revolutionary treatment was not so perfect, in 1944 a rather dissatisfied patient called his name in the street and shot him in the spine, paralysing him for life. As a consolation he received the Nobel prize for his contribution to science in 1949.Surgery is used only as a last resort where the patient has failed to respond to other forms of treatment and their disorder is very severe. This is because all surgery is risky and the effects of neurosurgery can be unpredictable and there may be no benefit to the patient and the effects are irreversible.
Strengths of the biological model:
The main strength of the model is that drugs have been successfully used to treat a wide variety of mental disorders, they have allowed people the chance to live independently and as normal life as possible without having to stay in hospital which prior to drug treatment was the only option. Where other therapies have failed, drugs have been successful, it has revolutionised the treatment of people with schizophrenia. Drugs have helped people improve sufficiently to allow psychotherapy and allow them a chance to gain insight into their illness. Drugs have also removed the stigma surrounding people with mental health issues so they are not blamed for being ill or accused of being possessed. Another strength of the biological approach is that it is very scientific, as the experiments used are measurable, objective and can be repeated to test for reliability. Also, the researcher has more control over the variables which is evident in Selye's study of rats which led to him developing the theory of General Adaptation Syndrome. The biological approach is also deterministic and increases the likelihood of being able to treat people with mental issue and provides explanations about the causes of behaviour, this understanding can then be used to improve people's lives.
Weaknesses:
One of the major weaknesses of the model is the side effects associated with drug or chemotherapy, as previously mentioned when outlining the different classes of drugs available. Most of these drugs can also cause dependency where people cannot cope without them and in some cases tolerance where the drugs actually have little or no effect. It’s also important to note that some other therapies may be ignored as busy doctors will prescribe medication rather than seek alternative means of helping the patient cope, in some cases people suffering from the stresses of daily life may be prescribed medication when exercise or relaxation could be more effective. Drug therapy also does not work for everyone such as people suffering from negative symptoms of schizophrenia where they have motivation or as it is more commonly known as Flatness of affect
Another weakness of the biological model is that it focuses too much on the 'nature' side of the nature v nurture debate. It argues that behaviour is caused by hormones, neurotransmitters and genetics. One theory is that schizophrenia is genetic, however, Bouchard and McGue (1981) twin studies show that it is not completely genetic and the environment has a part to play.
Another weakness of the biological approach is that it develops theories about disorders and generalises them to apply to everyone. It does not take into account the view that humans are unique. An example of this is that General Adaptation Syndrome assumes that everyone responds in the same way to stress but does not take into account that some people have more support than others. Szasz criticised drug treatment as inappropriate, rather people had a problem with living and therefore pills weren’t the solution.
Conclusion:
Whilst all the approaches have been criticised, they all offer some form of therapy which has positive benefits for the patient and more importantly in some cases have worked hand in hand with other therapies to help people live better lives. None of them can be overlooked as they are beneficial to some extent.
References:
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