Sample Chapter

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 Infl uences 118 7 Service Users and Survivors 139 8 Interventions 158

Part 2 Forms of Distress 191 9 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 infl uences 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 aff ec- tion 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 fi nding it diffi cult 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 receiv- ing 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 fi nd 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 4 CONCEPTS

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 diff erent from those of other books in this area. One very obvious diff erence 1 Explain why terminology is especially important in is that, unlike many others, we do not use the term ‘abnormal relation to mental health psychology’ to describe what our book is about (later, we off er 2 Explain what is meant in this book by ‘distress’ a detailed explanation for this). But in fact this book has several 3 Describe some of the problems associated with everyday distinctive features, so it will be useful to emphasize some of defi nitions of normality them here. 4 Explain the problem of thresholds in relation to First, in this book we take a consistently psychological psychiatric diagnosis approach to mental health. Usually, psychology books on 5 Defi ne key terms, including: service user, distress, mental health are already pre-structured in terms of psychi- madness, psychosis, neurosis, hallucination and delusion atric 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 Introduction labels, and explanations are typically directed at ideas of mental illness that have already been formulated within psychiatry or This book is about people like Bess. People distressed by life, medicine. Instead, in this book we off er a perspective that is their relationships, and their position in the social world. It is more suitable for students from non-medical backgrounds clear from Bess’s story that her distress is far from straightfor- who might want to train as (for example) clinical psycholo- ward. Do her diffi culties arise from her unstable relationships, gists, social workers or CBT practitioners. We have already from the way she thinks about the world, or the ways in which suggested that we will do this by starting with experience she has learned to cope? Whilst there are no easy answers to rather than notions of disorder, and there is more discussion these questions, we hope that this book will provide some of what this means later in the chapter. ways of thinking psychologically about the kinds of issues Second, most other books of this kind pay relatively little facing Bess and others who have had experiences like hers. attention to recent psychological research – much of it from In this chapter, we fi rst of all explain what is distinctive the UK – which has focused on particular kinds of experience, about this book and why we approached this topic in the way such as ‘hearing voices’, rather than diagnostic categories, that we did. We discuss the importance of terminology and such as schizophrenia. This research has shown that it is describe why language is important: both because it provides possible to make signifi cant progress in understanding and the concepts we use when thinking, and because of its links responding to people’s diffi culties without having to endorse to stigma and discrimination. We explain how in this book we psychiatric diagnoses. Of course, this does not mean that we will focus on distress (which for now you can simply read as don’t consider psychiatric diagnoses in this book – just that meaning ‘mental illness’ or ‘psychopathology’), and how we we don’t treat them as necessarily explaining people’s mental will treat distress as a form of experience – something that health diffi culties. happens within the life and the subjective awareness of a Third, many other textbooks claim that dimensional person – rather than as a form of illness. models are less clinically useful than psychiatric diagnoses. Then we give some of the reasons why we decided not to Dimensional models do not presume a sharp dividing line call this a book about ‘abnormal psychology’. Approaches to between mental health and mental illness, and recognize that mental health and illness that do not endorse simple notions all of us, sometimes, have distressing and unusual experiences of abnormality are often described as anti-psychiatry: this in our lives. They are usually contrasted with categorical is the collective term for a set of disparate work, published models, where mental illness is clearly distinguished from mostly in the 1960s, which rejected the view that mental mental health and is thought to fall into specifi c, separate health problems are illnesses or diseases. We explain why we categories: psychiatric diagnosis exemplifi es this approach. do not call our approach anti-psychiatry; consider the issues But in the UK, at least, the vast majority of clinical psycholo- raised by a focus on distress as something that is perhaps ‘in gists use dimensional models in their clinical practice, so this the mind’; and briefl y describe some of the ways in which book frequently takes a dimensional approach. mental health professionals have modelled and conceptual- Fourth, most other mental health textbooks contain a series ized their fi eld. of chapters, each focused on a particular psychiatric diagno- These discussions are followed by a short overview of the sis. But although they present extensive information about rest of the book, and a guide explaining how to get the most each diagnosis, they rarely try to explain the associations out of reading it. and connections between them. Typically, textbooks claim to promote a biopsychosocial model of mental health – an Guiding questions approach within which biological, psychological and social infl uences are all considered or modelled together. But because As you read this chapter, you should bear in mind these they don’t usually contain very much discussion of the links two questions: between ‘bio’, ‘psycho’ and ‘social’, the model actually tends to remain relatively obscure. Moreover, because these textbooks 1 Why might we question the notion of abnormal are invariably structured around psychiatric diagnoses, they psychology? also tend to be reductive – in other words, they tend to treat 2 What are the implications of rejecting psychiatric biological infl uences as foundational, or as more important diagnoses in mental health? than others. By contrast, in this book we try to consider the PROOF FROM DISORDER TO EXPERIENCE 5 links between ‘bio’, ‘psycho’ and ‘social’ in a more nuanced mental health and illness, so that you can come to your own and conceptually sophisticated manner. conclusions. Finally, in these textbooks, the discussion of critics of psychia- Of course, in attempting to write about mental health in a try, and of the controversies associated with its diagnoses and diff erent way we had to think carefully about the language we assumptions, almost always seems to stop at the end of the 1960s. used. There are many reasons for this, but perhaps the most If one were to judge by such books, one might almost believe important is that language contains concepts that structure that all of the problems that these critics had raised were now our thinking. If we use concepts that are inconsistent or solved. But this is not the case, and in the fi ve decades since the unhelpful, our thinking can become muddled. This meant that 1960s there have been many more critiques of, and alternatives we needed to ensure that our approach was internally consist- to, psychiatry. These critiques and alternatives have come from ent, so it is to the issue of terminology that we turn next. 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 Terminology written entirely by mental health service users. In writing this book we have therefore made a number of One of the fi rst challenges in learning about the psychology of assumptions: for example, that psychiatric diagnosis does not mental health is the wide variety of terms and concepts used. necessarily provide the best way to approach mental health Like the language used in relation to any other real-world problems; that a more sophisticated psychological account of phenomenon, none of these terms is neutral or value-free. mental health problems will be useful; that mental health service All of them seem to imply something about the nature or the users have valuable things to tell us about mental health diffi cul- causes of the phenomena they describe, and all of them are ties and interventions. All authors have an assumptive frame- more closely associated with certain disciplines and perspec- work – a worldview within which certain things are implicit tives than with others. The term mental illness, for example, and simply taken for granted. These assumptive frameworks clearly suggests that our talk will be of matters related to health are rarely made explicit, but we thought it would be helpful for and sickness, that it will have a medical character but that it you to have a sense of our starting points and assumptions so will also take a mentalistic or psychological focus. Another that you can take them into account as you read the book. widely used term, psychopathology, makes exactly the same Importantly, we have not written this book as a polemic assumption because it adds the concept of disease – pathol- and we accept that you may agree or disagree with some of ogy – to the prefi x ‘psycho-‘, which is short for ‘psychological’. our judgements. Throughout the book we will be presenting In both cases, then, the terminology already assumes that our evidence for and against diff erent ways of conceptualizing perspective upon these phenomena should be a fundamentally

a-theoretical, instead of depending Another concern frequently raised BOX 1.1 upon concepts derived from theories. by critics is that the DSM has promoted What is the DSM? This means that it does not use earlier the medicalization of everyday life: in concepts such as neurosis: a collective other words, it encourages us to see ‘The DSM’ is The Diagnostic and term for forms of distress that involve everyday diffi culties and stresses (for Statistical Manual of the American exaggerations of everyday responses example, shyness) as ‘symptoms’ of Psychiatric Association. It contains (e.g. excessive worrying) but do not ‘illness’ that then require ‘treatment’. the diagnostic criteria that American involve distorted perceptions or Certainly, the number of separate psychiatrists use in their practice. In unusual beliefs. Whereas the concept of diagnoses within each version of the Europe and the UK, psychiatrists most neurosis was originally derived DSM has tended to increase with each often favour the slightly diff erent from psychoanalytic theory, the DSM revision, as the table shows. However, psychiatric diagnostic criteria set out purports to be no more than a set of advocates of diagnosis argue that in The International Classifi cation of descriptions of the disorders the system is simply becoming more Diseases (ICD), produced by the World frequently observed by clinicians. These accurate and refi ned over time, and Health Organization. However, although disorders are proposed by panels of that the changing numbers refl ect this they may use these criteria in their experts, and are subject to a consulta- process of development. practice, for research purposes UK and tion process and approval by a central European psychiatrists also tend to use committee before they can be included in TITLE YEAR DIAGNOSES the DSM. the manual. DSM 1952 106 Both the ICD and the DSM have been Despite this, critics argue that the DSM-II 1968 182 subject to frequent revisions. The ICD is DSM is far from value-free and neutral. currently on version 10, whilst the current They suggest that in practice the DSM-III 1980 265 DSM is known as DSM-IV-TR: version IV, DSM furthers the interests, not just of DSM-III-R 1987 292 text revision. As we went to press, both psychiatry, but also of the pharmaceutical DSM-IV 1994 297 DSM-5 (the APA seem to have changed and insurance industries (because, under DSM-IV-TR 2000 297 their numbering system) and ICD 11 were America’s insurance-based healthcare expected shortly. system, a diagnosis is needed in order to Chapter 5 contains a lengthy discussion At least in its current version, the reclaim the cost of treatments such as of psychiatric diagnosis and the issues DSM claims to be purely descriptive and medication). that are frequently associated with it. PROOF 6 CONCEPTS

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 signifi - cant 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 termi- nology from other areas of your studies. Because language supplies the concepts that structure our thinking and debat- ing – 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 How we see or represent the world depends on how we choose to very often used. Over the last 20 or 30 years, however, some frame it, as well as upon what there is in the world for us to see of those who experience distress have organized themselves into activist groups and campaigned strongly for a change of medical one, and that at its most basic level our concern is terminology. They have argued that the term ‘patient’ implies with people who are diseased or sick. a passive position where someone puts themselves in the We think that this assumption is incorrect. In our view, when hands of experts to be fi xed. Some also object that the term people are given diagnoses such as schizophrenia or depres- inappropriately focuses almost exclusively on the medical and sion it is neither accurate nor helpful to think of them as being biological aspects of care (e.g. medication), rather than adopt- medically ill or diseased. So in this book we will use the terms ing a more holistic approach. As a result of these objections, ‘psychopathology’ and ‘mental illness’ very infrequently, and some professionals now refer to those who use their services even then only when they are already being used by the people as clients. However, some groups have argued instead that whose work we are drawing upon. In their place, we will use they should be referred to as consumers (popular in the the term distress. When we use this term, we use it to refer to USA, Australia and New Zealand) or service users (popular just the same kinds of phenomena that textbooks of this kind in the UK), and many professionals have also taken up this usually call mental illness or psychopathology. We use distress language. to mean all of the diff erent kinds of diffi cult or unusual experi- But these terms have also been challenged. Some suggest ences associated with the hundreds of psychiatric diagnoses that they obscure the fact that many people are not always will- currently employed. Distress is our term for the core subject ing consumers of mental health services, unlike the consum- matter of this book: the experiences associated with diagnostic ers of other goods and services: some, for example, will be categories such as schizophrenia and depression, and with the receiving compulsory treatment. Such critics have sometimes work of professions such as clinical psychology, psychiatry, suggested that the term recipient is more accurate. And yet social work and nursing. others have argued that, because they have had to cope not However, to reduce repetitive language, we will occasionally only with their distress, but also with psychiatric interventions draw on other phrases like ‘mental health problem’. This termi- which they have experienced as negative or unhelpful, the nology is also open to challenge, because by locating these term psychiatric system survivor is most appropriate. experiences in relation to health it also implies a link to illness. In short, then, there is no ‘right’ term to use and people in However, it is more ambiguous than ‘mental illness’, carries distress, like everyone else, have their own preferences and less conceptual baggage, and is easily understood because it understandings. In this book we will usually use the term ‘serv- is widely used. ice user’, since this is one of the terms most widely used in the Similarly, we will sometimes use the term madness to UK. But we will also sometimes use other terms, where other collectively describe experiences associated with the more people have used them or where the context demands it. PROOF FROM DISORDER TO EXPERIENCE 7

Stigma and discrimination these illnesses are what psychiatric diagnoses describe. The second assumption is that this will result in less discrimina- Language and terminology are important because of how they tion, because people will be more tolerant if they think that an aff ect our thinking. However, they also matter in relation to unusual behaviour is caused by a medical illness or disease; service users and their experiences of distress because of the otherwise, they might hold the person morally responsible. widespread discrimination to which such people are subject. Another problem noted by some critics of these campaigns is The UK government regularly surveys public attitudes about that stigma is seen as caused by problematic attitudes located ‘mental illness’: a survey (Offi ce for National Statistics, 2010b) inside individuals, rather than as a product of, or reaction of 1,745 people revealed that to, discrimination at a societal level – in a similar manner to sexism and racism (Sayce, 1998). • 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 under- standing this ambivalence is to see negative attitudes as an example of stigma. This approach draws upon sociologist Erving Goff man’s (1963) work Stigma: Notes on the manage- ment 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 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 were mentioned by the young people, including terms such mental health problems, or does it challenge their stigmatization? What as nuts, psycho, loony, weird, freak, spastic and demented. does it suggest to you about the causes of distress? 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 A number of studies have reported that, whilst the public may of schizophrenia as unpredictable and dangerous, even though use medical terminology, they place a ‘greater emphasis on about half of them knew someone with a mental health prob- psychosocial than biogenetic explanations of schizophrenia’ lem. Unfortunately, research also shows that such prejudiced (Read et al., 2006, p. 311). Moreover, contrary to the assump- views are even reported amongst doctors (Mukherjee, Fialho, tions of the anti-stigma paradigm, biomedical explanations Wijetunge, Checkinski & Surgenor, 2002) and may be made are associated with more negative attitudes and behaviour worse by some nurse training (Sadow, Ryder & Webster, 2002). than psychosocial models, in which mental health problems Despite a huge amount of money spent on ‘anti-stigma’ are seen as psychological in nature and caused by adverse campaigns the eff ects on public attitudes have been modest, life events and circumstances (Lam, Salkovskis & Warwick, leading some to suggest that attitudes about mental health 2005; Mehta & Farina, 1997; Read & Harré, 2001; Read et al., may be diff erent from other attitudes (Crisp et al., 2000). 2006). Why might this be? One possibility is that, if unusual However, in a recent review, Read, Haslam, Sayce and Davies experiences or behaviours are seen as biomedical in origin, (2006) suggest that it may be the underlying assumptions of they become more mystifying and unpredictable. Conversely, the anti-stigma paradigm which are the reason for the lack of if they are seen as the result of someone’s life experiences, change. These approaches are typically based on two assump- they are perhaps more understandable. So public education tions, the fi rst of which is that the public need to be taught to programmes focusing on psychosocial explanations may well adopt a biomedical model of distress – to assume that distress fare better than those that endorse biomedical approaches (see is caused by diseases or illnesses of the brain or mind, and that 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 Sees problems as an understandable response to adverse life illness events Sees societal reactions as due to the stigma attached to having a Sees societal reactions as due to discrimination against a mental health problem marginalised group (like racism, sexism etc) Aim of public education is to remove perceived blame attached to Rejects the relevance of notions of ‘blame’ and aims to promote the individual by ‘blaming’ the illness rather than the person 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 diff erent’

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

Discrimination reported that reliance on fi ctional television was associated Although many people experience mental health problems, with higher ratings of unpredictability. there is now substantial evidence that mental health service Rose (1998) compared UK TV news coverage in the summer users experience signifi cant discrimination across all areas of and winter of 1986 with TV news and other programmes their lives (Sayce, 2000). For example, only 24% of people with between May and July 1992. Although she found variety in TV long-term mental health problems were in work in England in genres like soap operas and comedies, the category of danger 2003 – the lowest employment rate of any of the main groups was very frequent. For example, a third of all camera shots in of people with disabilities (Social Exclusion Unit, 2004). Almost her collection of TV news relevant to mental health dealt either half (47%) of Read and Baker’s (1996) respondents said that they visually or verbally with danger, violence and crime. Moreover, had been abused or harassed in public. Berzins, Petch and on the news, nearly two thirds of all stories involving those Atkinson (2003) reported that people with mental health prob- with psychiatric diagnoses fell into the category of crime news, lems suff ered much higher rates of verbal abuse and physical although crime news accounts for only 10% of news coverage. harassment than the general public, with much of it commit- As well as increasing the general public’s fear, negative media ted by teenagers and neighbours. representations have an impact on people with mental health Sadly, discrimination intrudes into even the most intimate problems themselves. Half the respondents of a UK mental relationships and can lead to many people with mental health health charity’s survey of mental health service users said that problems feeling isolated (Mind, 2004) and being wary about their mental health had been negatively aff ected and a third telling other people about their own or another’s distress said others had reacted negatively towards them as a result of (Mental Health Foundation, 2000). There has also been an such reports (Mind, 2000). increase in community opposition to nearby mental health The media bias against mental health service users is facilities. Research suggests that residents’ fears are fuelled by especially unhelpful because it largely ignores the available media reporting, and are associated – on occasion – with both evidence. A UK study found that murders by mental health vandalism and assaults (Repper, Sayce, Strong, Willmot and service users are infrequent and occur less than once a week Haines, 1997). (Large, Smith, Swinson, Shaw & Nielssen, 2008). Whilst this Another domain within which mental health service users might sound alarming at fi rst, it should be seen in the context experience discrimination is the media. Headlines such of other statistics. First, only 10% of people convicted of murder as ‘Schizophrenic Given Life for Murder’ (Daily Express, 24 in the UK are thought to have any mental health diffi culties March 2009), and terms such as ‘Psycho Cabbie’ (The Sun, 4 at the time of their crime (Department of Health, 2001), and June 2010), serve to associate mental health service users with 95% of all murders are committed by people who have never violence and fear and help to spread negative attitudes. Indeed, been given a psychiatric diagnosis (Institute of Psychiatry, many commentators see disproportionate media report- 2006). Second, the number of people experiencing mental ing as an important maintaining factor in more widespread health diffi culties at any one time is large – typically around discrimination. In one study of a range of print and broadcast one in six of the population, or – in the UK – roughly 7 million media, stories about homicides and crimes accounted for 27% people. These fi gures show that the vast majority of murders of all coverage of mental health (Care Services Improvement are committed by people without mental health problems, and Partnership/Shift, 2006). Messages about the risks of violence that the proportion of people with mental health problems posed by people with mental health problems were present in who commit murder is extremely small. Other violent attacks 15% of stories, most of which implied the risk was high. by mental health service users (i.e. those not causing death) are News and entertainment media focus primarily on violence similarly much less frequent than media reporting suggests, against others when addressing issues relating to mental and when they do occur they are frequently also associated illness, with these items receiving ‘headline’ treatment (Philo, with the use of alcohol or other drugs (Fazel, Langstrom, Hjern, 1994). These fi ndings are robust (e.g. CSIP/Shift, 2006; Philo, Grann & Lichtenstein, 2009). 1996; Pinfold & Thornicroft, 2006) and infl uence the public’s In fact, contrary to public fears, people with mental health fear of unpredictability and violence (Philo, 1996). Levey and problems are far more likely to be victims of violence than Howells noted (1995) that perceived dangerousness was not perpetrators; for example, they are six times more likely than as important as the perceived diff erence and unpredictability the general population to die by homicide (Hiroeh, Appleby, of people with a diagnosis of schizophrenia. Moreover, they 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 From our perspective, however, experiences of distress are victims of violent crime than to be arrested for committing part and parcel of the other experiences of everyday life. They violence themselves (Walsh et al., 2003). They are also far more do not form a separate, unitary category of symptoms that can likely to be a danger to themselves than to other people; for be understood separately from everything else. Experiences example, one infl uential study found that 90% of UK suicides associated with distress – just like every other experience – are involve people with mental health problems (Barraclough, bound up with social and material conditions, personal biog- Bunch, Nelson & Sainsbury, 1974). raphies, life events and relationships. And, just like every other How might we change stigmatizing attitudes and discrimi- experience, they are infl uenced by our biological capacities, by natory behaviour? As we have seen, promoting psychosocial the many, variable potentials produced by our nature as living, rather than biomedical explanations may help. In addition, organic beings. activists like Sayce (1998, 2000) have argued that lessons can be But if distress is not separate from other aspects of experi- learned from broader disability campaigns. Here, campaigners ence, and does not form a unitary category all to itself, how can argued that it was not a person’s disability which was the prob- we know where it starts and ends? How can we reliably and lem (as might be expected from an individualistic biomedical validly draw an objective line between distress – the province approach), rather it was the way in which society unintention- of services such as clinical psychology and psychiatry – and ally created barriers by organizing the environment in a way more everyday experiences of being unhappy, worried and so which was convenient only for people without a disability. In on? the same way, rather than focusing on individual experiences Simply put, our answer is that we cannot draw such a line. of stigma, we might see public attitudes to service users – We do not believe that it is possible to produce a set of criteria fuelled by inaccurate media reporting – as socially-created or defi nitions that transcend history, place and culture and barriers to their acceptance by others. 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 What is distress? abnormal is taken for granted – even though it is recognized that only appropriately trained expert psychiatrists might be Throughout this book, then, we use ‘distress’ as a generic able to determine exactly where it lies. By contrast, we believe term to refer to all the phenomena and experiences that are that there is no value-free distinction between behaviours and sometimes called ‘psychopathology’ or ‘mental illness’. But, experiences that are considered normal and those that are as we have suggested, this is not just about a preference for a considered abnormal. Neither is there any universal standard diff erent way of describing these experiences: it also signals a against which people’s emotions, thoughts and actions can diff erent way of conceptualizing them. We will now describe be judged, and by reference to which they can be categorized in more detail how we conceptualize distress, and how – as as deviant. On the contrary, the identifi cation of distress as a concept – it diff ers from concepts of mental illness or distress will always be entwined with prevailing cultural norms psychopathology. of emotionality, behaviour and morality. When we talk about distress, we are talking about a highly However, this does not mean that cultural norms are the sole variable and heterogeneous set of experiences. These experi- criteria against which distress might be identifi ed. Sometimes ences can include a person’s ways of acting or experiencing can make it diffi cult for them to live their lives as they would like, or can have a bad • strong or overwhelming emotional states, of various eff ect upon their physical health. When this happens, their kinds, that disrupt everyday life and prevent people from behaviour is never somehow fl oating free of cultural norms: functioning what we want to do in our lives, for example, is continuously • habitual and repetitive patterns of acting – for example, infl uenced by the precepts, norms and values of our time and in relation to personal hygiene, or to do with safety and culture. security – that create anxiety if they are not carried out Nevertheless, there are patterns of activity and experience • experiences of seeing and hearing things that other people which would be unhelpful or damaging in most circumstances. do not see or hear, or of holding beliefs that are considered Gradually starving yourself – perhaps because you have come by others to be unusual and extreme. to believe that only by doing so can you begin to meet all of In this book, we take these kinds of experiences as problems the many expectations placed upon you – will damage your in their own right. This contrasts with the approach frequently physical health, no matter where or when you live. Similarly, taken in psychiatry, where service users’ talk of these kinds being so profoundly miserable that you are unable even to get of experiences can very quickly get re-interpreted as nothing out of bed is likely to prevent you from achieving your goals, more than symptoms of an illness. In psychiatric settings, whatever those goals are. In the same way, experiencing angry doctors are frequently listening out for particular patterns and abusive voices that no-one else can hear is likely to make of diffi culty in order to match the person’s experience with you frightened, confused and distracted, and this will probably a pre-defi ned diagnostic category. However, this might occur to some extent even in cultures where voice-hearing mean that they miss some of the complexity and fl uidity of is not as thoroughly stigmatized as it is in the West. So, whilst people’s actual experiences of distress: in attentively looking these dysfunctional or damaging consequences are defi nitely for patterns of symptoms, they may fail to notice the ways in not separate from wider cultural norms and values, they do not which people’s distress is linked to the circumstances of their arise solely because of them: they are also a product of specifi c situations. As a consequence, rich accounts of distress that patterns of experience and activity. engage with its meaning and detail in a person’s life may be To some extent, distress can also be identifi ed with respect diffi cult to achieve from within a psychiatric framework. to the extent to which a person’s actions and experiences PROOF 10 CONCEPTS are unusual and inexplicable. Again, cultural norms play an like these those norms are either mediated by other people’s important role here, and in two ways. First, almost by defi ni- experiences, or codifi ed in legal or other requirements. These tion, norms refer to the ways of acting and experiencing examples show how the identifi cation of distress can be a displayed by the majority. However, there are diffi cult issues compassionate move, perhaps by attempting to keep safe involved in trying to agree the threshold at which an experi- someone who might otherwise be a danger to themselves. But ence becomes seen as clinically signifi cant (see Box 1.2 for a they also show how distress is always bound up with the wider discussion). Second, norms are relevant because we are far structures of power that organize our lives, and by which more ready to ascribe distress to people when their ways of interventions might be imposed against our will. being in the world do not make sense to us. When what people To summarize: distress is always conceptualized with respect say or how they act is not only unusual but also seems to lack to cultural norms, but these norms are not the sole criteria any obvious explanation, we are more likely to conclude that against which distress is understood. One consideration is they are experiencing distress of some kind. In other words, it that distress always has a subjective component, regardless of is not just the frequency or rarity of someone’s acts and expe- its location within culture. Another is that, intersecting with riences that counts – it is also the sense or the meaning that cultural norms, we also have we are able to give to them. • Judgements about the extent to which a person’s actions Another issue is that there are signifi cant numbers of people and experiences are harmful or dysfunctional who receive treatment from psychiatric or clinical psychologi- • Judgements about the extent to which they are unusual cal services but who do not want these interventions. Some • Judgements about the meaning of actions and might be experiencing the transient states of extreme euphoria experiences and intense energy that psychiatrists call mania; others might • The infl uence of power relations be hearing voices that are friendly and supportive, rather than angry or abusive; yet others might be very unhappy, worried None of these judgements is simply objective, just as the or confused, but have nevertheless come to believe that the operation of hierarchical power relations cannot simply be treatments are not working, or that they produce as many seen as ‘objectively’ correct. But whilst these judgements and diffi culties as they solve. Some such people might end up infl uences do not escape the infl uence of cultural norms, they receiving services, not because they themselves are distressed, are not identical to them, either. Instead, they point to numer- but because their behaviours and experiences are distressing ous ways in which the contexts, consequences and meanings to others around them. Others may end up receiving services of experience are part of its conceptualization as distress. They because their behaviour leads them to fall foul of the law. make it clear that distress is always socially and culturally Again, cultural norms are highly relevant here: but in cases positioned, that it will vary according to the specifi cs of time

anxiety, fi nding that 61% of respondents begin to ask why so many people experi- BOX 1.2 reported being much or somewhat ence a DSM-defi ned disorder at least The problem of thresholds more anxious than others in at least one once during their life-times, and what of the seven social situations surveyed. this prevalence means for etiological We have seen that one criterion for However, if the threshold at which theory, the construct validity of the DSM identifying experiences as mental health a person’s distress was considered approach to defi ning disorder, service problems is how unusual they are. But clinically signifi cant was moved, the delivery policy, the economic burden of what is the threshold beyond which an prevalence of ‘social anxiety syndrome’ disease, and public perceptions of the experience is considered so unusual varied from 1.9% to 18.7%. Many diagnos- stigma of mental disorder’ (p. 907). that it is signifi cant? This question is tic criteria are formulated without any Because there are cultural norms important, because research shows empirical investigation of base rates in about what might be regarded as that some phenomena associated with the general population. This may explain grounds for distress, where the threshold distress are far more common than is why there is a frequent disparity between for distress is set will have a considerable usually supposed. numbers of people seen by mental impact. One US study has suggested that Of a random sample of 7, 076 health services and numbers of people in ‘about half of Americans will meet the Dutch people, Van Os, Hannsen, Bijl community surveys who meet diagnostic criteria for a DSM-IV disorder sometime and Ravelli (2000) reported that, whilst criteria. in their life’ (Kessler et al., 2005, p. 593). 3.3% had ‘true’ delusions (i.e. meeting Moffi t et al. (2010) have suggested If half of the population experiences all diagnostic criteria) an additional 8.7% that many estimates of prevalence in something, is it unusual? To some extent, had delusions that were ‘not clinically community surveys undercount because this depends on one’s worldview. For relevant’ – that is, they were ‘not they rely on retrospective accounts. example, Sigmund Freud, one of the bothered by it and not seeking help for it’ Their prospective study, which followed founders of psychoanalysis, did not see it (van Os et al., 2000, p. 13). Similar fi ndings participants between the ages of 18 as his job to make people happy: instead have been reported in relation to hearing and 32 and interviewed them four times he simply argued that ‘you will see for voices (see Chapter 11). during this period, found prevalence rates yourself that much has been gained if we Stein, Walker and Forde (1994) for DSM diagnoses that were twice those succeed in turning your hysterical misery conducted a telephone survey in Canada of other national surveys. They conclude into common unhappiness’ (Freud & to ask about experiences of social by suggesting that ‘researchers might Breuer, 1895/2004, p. 306). PROOF FROM DISORDER TO EXPERIENCE 11 and place, and will be patterned according to broader socio- culture (Hebdige, 1979). Social defi nitions recognize the cultur- logical variables such as socio-economic status, gender and ally normative dimension of distress that we described above, ethnicity. Conceptualized in this way, distress is quite diff erent but when we try to formalize them it becomes apparent that from mental illness or psychopathology, both of which imply we also have to invoke other (typically unspecifi ed) criteria objective disease states that can be identifi ed in ways that are to decide which social norms, when, and where, to use as the distinct from cultural norms. basis of our decisions. So concepts of normality and abnormality do not provide an objective basis for the identifi cation of mental illness or Why not abnormal psychology? 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 Our claim that there are no objective criteria by which distress to the majority of psychology lecturers and students. Despite can be distinguished from other kinds of experience is a chal- this, there are other reasons why we choose not to describe lenge to the idea that some kinds of experience – and perhaps this as a book about abnormal psychology. 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, Abnormal psychology is confusing which are typically described as books on abnormal psychol- and unclear ogy. This term is very widely used, perhaps because classifying One reason we haven’t used the term ‘abnormal psychology’ some kinds of experience as abnormal makes it reasonable to is that it is ambiguous: is it the psychology itself that is abnor- describe them as expressions of psychopathology or mental mal, or does the term refer to the psychology of abnormality? illness. Since abnormal psychology is such a common term, Common sense would suggest that it is the second of these we should explain why we do not use it in this book. options that most people have in mind; if so, this only leads to Whilst the notion that trained professionals can use objec- a second, thornier set of confusions. tive criteria to distinguish between normality and abnormality As we have already discussed, there is no straightforward, is perhaps comforting, it is nevertheless mistaken. Speaking objective way to distinguish abnormal behaviours and experi- very generally, formal defi nitions of abnormality can be ences from normal ones. Even more fundamentally, though, classed as medical, as statistical, or as social – but whichever it is impossible to easily identify a body of psychological kind of defi nition we use, we encounter contradictions and theory and practice that is both exclusive to abnormality and problems. Each kind of defi nition excludes some phenomena unconnected with other topics. Psychological explanations in we might intuitively want to defi ne as psychologically abnor- abnormal psychology tend to draw upon just the same kinds of mal, includes some we would not want to defi ne as abnormal, paradigms and theories as other psychological explanations – or smuggles elements of subjective opinion into what are biological, cognitive, behavioural, social, developmental and so ostensibly objective judgements. on. It does not seem necessary to assume that the psychologi- For example, if we use a medical defi nition of normality, cal processes that occur in distress are fundamentally diff er- we will tend to class as normal those activities which contrib- ent or abnormal in comparison to those that occur in other, ute to health and wellbeing, and class as abnormal those that supposedly normal, experiences. There are many successful endanger life or wellbeing or which cause harm to bodily psychological models of distress that draw upon established organs or tissues. But this means that many highly prevalent psychological theories and concepts such as learning theory, everyday activities – such as smoking, drinking alcohol, diet- attribution theory, schema and so on. ing, extreme sports, body-piercing and tattooing – would be classed as abnormal, because they all involve actual or poten- Abnormal psychology is not consistently tial damage to the body. psychological If we use a statistical defi nition of normality, we will class as abnormal those activities, behaviours and characteristics A further way in which abnormal psychology is confusing is that are, numerically, relatively unusual in a given population. that it is not consistently psychological. Frequently, abnormal Statistical defi nitions of normality derived from psychology psychology entirely abandons psychology and turns instead sometimes use psychometric instruments, normal distribu- to psychiatry. This is clearly demonstrated in the overall struc- tions and similar procedures by which to distinguish those ture of most textbooks, which typically follow, more or less who are abnormal from those who are not. But without also faithfully, the diagnostic categories associated with one of the drawing on cultural values and norms (for example, in decid- major psychiatric diagnostic systems such as the DSM or ICD. ing which experiences to include in psychometric scales) But this necessarily means that the inconsistency also runs statistical defi nitions will always generate contradictions, deeper: even where psychological explanations are off ered, because some highly valued attributes – being a member of they are directed at problems already defi ned in psychiatric the royal family, perhaps, or excelling at sport – are statistically terms. So in abnormal psychology there is an unresolved highly abnormal. tension between psychiatry and psychology, and frequent If instead we use a social defi nition of abnormality, this will shifts from one to the other. Moreover, when this happens, refl ect the specifi c kinds of activities and experiences approved abnormal psychology typically off ers no rationale for this shift or disapproved of in that time and place, so will inevitably be from a psychological mode of explanation and description to a subject to marked variation. This variation operates within as medical, psychiatric one. well as between cultures: groups and subcultures have their In this textbook, we try to avoid these confusions by present- own norms of behaviour and conduct that sometimes diff er ing consistently psychological accounts of distress. This does signifi cantly from those of the dominant or mainstream not mean, of course, that we entirely ignore psychiatry: this PROOF 12 CONCEPTS would be impossible, given that so much of the evidence we will tend to possess a limited and restrictive set of conceptual have about distress is associated with it. Nor does it mean that frameworks when they themselves, or people in their lives, we ignore any of the multiple facets of distress, such as its encounter mental health problems. These limitations, and biological, cognitive or developmental aspects. the assumptions of abnormality which they reproduce, may However, it does mean that we treat psychological explana- act as barriers to people’s ability to understand diffi culties and tions of distress as suffi cient in their own right. Rather than respond to them appropriately. subordinating them to psychiatry by applying them only to Of course, all teaching and learning starts from a set of problems defi ned in the fi rst instance as medical and psychiat- assumptions about what we imagine to be the nature of the ric, we also use psychology to defi ne the nature and character topic and what students need to learn about it. We do not imag- of people’s distress. ine 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 Abnormal psychology is unhelpful from will prove more helpful and appropriate for psychologists A third reason we haven’t used the term ‘abnormal psychol- and many others who wish to engage with this topic. ogy’ 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 Isn’t this just anti-psychiatry? that most readers will know someone who has experienced it (see Box 1.3). Some readers might consider that our arguments so far are In this context, teaching that is framed from the outset as ‘just anti-psychiatry’. By this, people mean the work of psychi- being about something abnormal will already import a range atrists and others in the 1960s, like Ronald Laing in the UK and of assumptions that, for many readers, are likely to be diffi cult Thomas Szasz in the USA, both of whom were critical of the or unhelpful. It is hard to engage constructively with teach- legitimacy of psychiatric claims. As we will see in Chapter 2, ing that labels you, or the people you love and care for, as the so-called anti-psychiatrists were not a homogenous abnormal. group, and there were important diff erences between the key Even more seriously, this unhelpful aspect of abnormal fi gures. Moreover, both Laing and Szasz were unhappy with psychology is not confi ned to its likely eff ects upon the learn- the term ‘anti-psychiatry’, and they were clearly not against all ing and teaching of psychology. Although the majority of ideas and practices in this area, since they both continued to people who study psychology do not go on to have careers practise psychotherapy. in the profession, they will nevertheless draw upon what they Many modern abnormal psychology and psychiatry text- have learned at other points in their lives. This means that they books give the impression that the challenges raised by the

such people, and that the people they in a manner which does not get in the BOX 1.3 knew were most often family members. way of our lives or cause signifi cant I know someone who has a She observed that taking part in such a diffi culties for us or those close to us). mental health problem class is not ‘simply an abstract academic Thus, if you feel that you are a little exercise; it is a potential source of obsessive because you like things to be Many readers of this book will either knowledge and skills that could have a neat and tidy, it does not mean you have know someone who has had a mental signifi cant impact on students, families a disease called obsessive compulsive health problem, will have experienced a and friends’ (Connor-Greene, 2001, p. 211). disorder. This self-recognition problem problem themselves, or may do so in the We take this point seriously. is very common. If you asked the other future. UK mental health campaigners Throughout the book we have sought to students in the class if they have started suggest that about one in four people portray people in distress in a respectful to question whether they have a mental will, at some point in the course of manner, and to avoid an ‘us and them’ health problem, we think it is likely they their lives, experience clinical levels of attitude. We have tried to investigate will say that they have too! distress. Elsewhere in this book, we ask and present the evidence behind, for If, however, you do have a problem whether such fi gures challenge common example, claims about particular mental that is long-lasting, and that is causing defi nitions of mental illness based upon health interventions, so that readers of diffi culties that get in the way of your notions of organic disease and dysfunc- the book can act as informed citizens life and causing you further distress, tion. For now, all we need to recognize is when helping a family member to then you should consider seeking help. that such experiences are very common, weigh up the pros and cons of diff erent Most universities and colleges have so if you have experienced distress – or intervention options. mental health or counselling services, know someone who has – you are not When reading about mental health, and these can be an appropriate place alone. one can easily start to recognize oneself to start. For those who are not students, In a survey of students attending an in the descriptions of certain kinds of local voluntary services in your area can abnormal psychology class in the US, problem. As we will see in later chapters, usually be identifi ed by searching the Patricia Connor-Greene (2001) found that studies of the normal population suggest internet. You could also try discussing almost every student reported knowing that many mental health problems are your diffi culties with your GP, who – if it someone with a mental health problem, normally distributed, such that a lot of is appropriate – will be able to refer you that quite often students knew several us experience them at a low level (i.e. to more specialist services. PROOF FROM DISORDER TO EXPERIENCE 13 anti-psychiatry movement were addressed with a new edition place since the 1960s. The term ‘anti-psychiatry’ seems to of the DSM in the 1980s. However, this new manual did not exclude all of this more recent work, is simplistic, and carries far solve the more fundamental conceptual problems noted by too much historical and conceptual baggage; for these reasons these critics – for example, that value judgements are neces- we would not use this label to characterize our approach. sarily involved in defi nitions 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 From disorder to experience there are for infections or viruses. Moreover, there has been a considerable body of empirical research over the last fi fty Most mental health textbooks, then, focus on psychiatric years which has cast new light on some of the debates which disorders; Box 1.4 shows how disorder is typically defi ned began in the 1960s. Throughout the book we will draw on this within psychiatry, and discusses some problems associated research to demonstrate that there are continuing problems with such defi nitions. By contrast, in this book we focus on with the validity and reliability of diagnostic constructs. experience. By this we mean that we will describe and try to Likewise, we will draw on this research to show that a focus explain experiences of distress without presuming that they on the experience of forms of distress can yield results that are are always caused by an underlying disorder of some kind. valuable to service users, researchers and clinicians. We will treat the diffi culties themselves as something to be It may help here to consider some of the debates in other explained, rather than attributing them to an underlying areas of psychology, for example between diff erent approaches disorder that in fact may not even exist. to social psychology or between paradigms like learning In the last few years there has been a growing tendency theory and psychoanalysis. Here, too, there are debates about for psychology to engage directly with the particularities of assumptive frameworks, key concepts, terminology and experience itself, rather than, for example, engaging with methodology. In these areas, too, we have had to accept that general biological or cognitive capacities. There have been research is always, to some degree, a refl ection of its time, three recent books on the psychology of experience, each one aff ected by cultural norms and so on. Our contention is that taking a slightly diff erent focus. Ben Bradley (2005) empha- this is also true in mental health, so throughout the book you sizes that experience is always relational and shaped by the will see debates analogous to those found in other areas of simultaneous experiences of other people. He also discusses psychology. ways of thinking about the signifi cance of time in relation to In short, there are some similarities between aspects of our experience. Dave Middleton and Steve Brown (2005) show how approach and the ideas of the anti-psychiatrists, but there are our experience is made in part from our memories, exploring also signifi cant diff erences. This book refl ects the fi ndings of how they help give meaning to everything we see, hear and the nearly fi fty years of research and discussion that has taken feel. Niamh Stephenson and Dimitris Papadopoulos (2007)

This defi nition raises many issues that of disorder is inescapably social in BOX 1.4 recur throughout this book: whether character. DSM-IV defi nition of mental or not distress should be seen as a However, as Kirk and Kutchins disorder medical or biological problem, the (1999) observe, we can only reliably relationships between individuals and identify a dysfunction if we can say In DSM-IV each of the mental disor- their culture, the kinds of reactions with confi dence what the function of a ders is conceptualized as a clinically we should expect people to show to system or organ is meant to be. signifi cant behavioural or psychologi- unpleasant but common experiences But in relation to human minds and cal syndrome or pattern that occurs in an individual and that is associated such as bereavement, and so on. brains, our knowledge of these with present distress (a painful Notably, however, the defi nition also functions is still remarkably limited. For symptom) or disability (impairment displays a continual concern with example, we know that many neural in or more areas of functioning). This notions of dysfunction, and this raises systems frequently serve more than syndrome or pattern must not be some complex issues. one function, that most basic abilities merely an expectable and culturally For example, Wakefi eld (1992) are enabled by multiple neural systems sanctioned response to a particular distinguishes between disorder and working in parallel, and that there event, for example the death of a dysfunction. He argues that a disorder are frequently many diff erent neural loved one. Whatever its original is a harmful dysfunction, and that what pathways by which the same cause, it must currently be consid- is considered harmful will be judged (or a similar) behavioural or cognitive ered a manifestation of a behavioural, according to prevailing social norms. goal can be reached. They argue psychological or biological dysfunc- By contrast, a dysfunction – for example, further that many forms of distress tion in the individual. Neither deviant of a cognitive mechanism designed to are probably not dysfunctional in any behaviour nor confl icts that are conduct a specifi c function – might be simple sense: for example, that it may primarily between the individual and identifi ed objectively, so is not subject to well be ‘natural’ and a sign that your society are mental disorders unless the same kinds of infl uences or biases. neural systems are working as they the deviance or confl ict is a symptom This suggestion is insightful: it avoids should if you end up feeling deeply of dysfunction in the individual. many of the diffi culties associated with miserable because you have lost your Reproduced in Stein et al. defi nitions of normality and abnormality job and have no immediate prospect of (2010, p. 1760) whilst also recognizing that the notion getting another. PROOF 14 CONCEPTS focus mainly on the ways in which experience is shaped by Like all of the other examples in this book, these are fi ctional – the wider power relations of society, relations which regulate they are not descriptions of real people. Nevertheless, they are our experience and – at the same time – create contradictions fi ctions closely informed both by clinical practice and by the that can put us somewhat at odds with their requirements. research literature describing mental health diffi culties. This These diff erent perspectives on experience begin to show means that we can use them to draw out important issues that how it always spreads in two directions: ‘outside’ ourselves, are relevant to our understandings of distress – for example, into the social and material circumstances that give experi- how people are socially positioned. Dave is a middle-class ence its character and content, and ‘inside’ ourselves, by way professional, whereas Ellie and Mark are less wealthy and have of the many thoughts, feelings and memories it consists of. fewer resources. Studies show that the incidence of psychiatric In this book we will try to explore experience from both of diagnoses varies with wider economic and social conditions these directions, in the hope that by doing so we can make and is patterned according to sociological variables such as even superfi cially baffl ing experiences more open to expla- class or socio-economic status, gender and ethnicity. Similarly, nation. The alternative – attributing what we cannot readily there is much evidence that women are more likely to be understand to the eff ects of an underlying disorder – tends given some psychiatric diagnoses than men, and that overall to produce unsatisfying, circular explanations: we know that they are more likely to experience distress. Nevertheless, as Jenny has schizophrenia because she hears voices, and the our examples illustrate, at the individual level these infl uences reason she hears voices is because she has schizophrenia. appear complex and uneven. Whilst the kinds of experiences we will consider are quite Ultimately, each of our examples is an attempt to reduce the varied, they are all of the kinds that mental health profession- messy complexity of a lived experience, in all its uncertainty als might encounter in the course of their work. At the start of and ambiguity, to a single narrative told from a specifi c point this chapter we presented Bess’s story and suggested that her of view. Inevitably, doing this raises issues. For example, there experiences are fairly typical of those that clinicians encoun- are always other stories that could have been told: even though ter. Here are some more examples: we have tried to illustrate something of the great diversity of distressing experiences, it is impossible to encapsulate the Dave is a 45 year old man who is frustrated with his career. variety of experiences being lived out around us all the time. So Although he has a well paid, highly respected job and a we could have told many other stories; but we could also have comfortable home, he is dissatisfi ed with other aspects of told the stories we did tell in diff erent ways. Mark’s stepfather, his life and his negative feelings have recently started to for example, might have told a story that emphasized Mark’s become overwhelming. At work, Dave feels that his talents unreasonable behaviour, and described how he frequently are not being recognized, and that his manager is a bully becomes aggressive without any apparent justifi cation. 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 fi nd 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 medica- tion 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 Both psychiatry and psychology are imbued with interests – for example, those of commerce and professional status. Although the problems has begun to hear angry male voices criticizing him. Mark associated with these interests may be more acute in respect of is terrifi ed by these experiences, but has not told anyone psychiatry, psychology does not provide a neutral ground from which to about them because he fears that people will laugh. 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 experi- enced 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 fi rst becomes a matter for intervention when people fl agrantly breach every- day 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 pronounce- ments 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 refl ects a set of interests. We have no defi nitive solution to these problems. We certainly cannot claim that the account we give in this book is somehow neutral, or that it fails to refl ect 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 Anything that is ‘in the mind’ is also a state of the brain and body for diff erent explanations of distress. And second, we have included in this book some of the views and perspectives of don’t understand it in these dismissive terms because there people who actually experience distress, so that our profes- is a clear and visible explanation for its severity. Those who sional perspectives can be balanced by perspectives from experience chronic back pain, by contrast, may also fall prey those who have actually received mental health services. to such discrimination: having a visible cause for pain – or for distress – helps. All in the mind? Third, the experiences of distress that are categorized by psychiatric diagnoses are, in any case, overwhelmingly psycho- By rejecting psychiatric disease categories we might appear logical in character. There are no reliable biological markers for to be denying the reality of people’s distress: if the categories diff erent diagnoses, no blood tests or scans that can be used to aren’t real, are we saying that the distress isn’t real, either? make diagnoses of depression or schizophrenia. Instead, there This is not the case. We have not based this book upon are reports – usually verbal – of various kinds of experience: psychiatric diagnoses because of the extensive evidence unusual beliefs, profound unhappiness, extreme agitation, regarding their lack of validity, poor reliability, dubious empiri- hearing voices and so on. These experiences may well also have cal grounding and much-discussed conceptual diffi culties (we aspects that are visible in the person’s bearing and manner: discuss this evidence in much more detail throughout the people who are deeply unhappy, for example, often talk more book, especially in Chapters 4 and 5). slowly than other people, and sometimes more quietly. They In place of psychiatric diagnoses, we advocate consistently may have diffi culty thinking of words or concentrating on the psychological explanations, but from a psychological perspec- fl ow of conversation, and may fi nd it hard to motivate them- tive, people’s distress is just as ‘real’ as it is from a psychiatric selves. But the existence of these bodily elements does not one. The pejorative term ‘it’s all in her mind’ is sometimes necessarily mean that there is a physical disease called depres- used to imply that psychological distress should be something sion, although it does demonstrate, again, that psychological we can simply overcome by an eff ort of will. It is a moral states are simultaneously states of the body and brain. judgement which ultimately implies that only those of weak Fourth, we should always keep in mind that even when character fall prey to psychological disorders. In this book we people’s own actions seem to be unhelpful and self-defeating, need to avoid such unjustifi ed moralizing, whilst holding on this does not mean that they are simply responsible for their to the idea that distress is fundamentally psychological. We own distress. Putting this another way, just because how we can do so in a number of ways. respond to our distress can make a diff erence to the outcome, First, we should recall that nothing is simply ‘all in the this doesn’t mean that individuals should be held personally mind’. Mind, body and brain are intimately joined together, responsible for failing to respond in what, from an outsider’s and anything that is ‘in the mind’ is simultaneously a state perspective, is the ‘correct’ manner. In actuality, most people’s of the body–brain system. The denigration of psychological room to manoeuvre is far more limited than it might at fi rst distress as being ‘all in the mind’, in other words, relies for its appear, and many simply do not have the resources to deal force upon the cultural commonplace of mind–body dual- with their situation in ways that are markedly diff erent. ism. Mind–body dualism – also sometimes called Cartesian Moreover, just like everyone else, when people experiencing dualism – refers to a tendency, common in Western distress make choices, they always do so with limited knowl- cultures and associated historically with the philosophy of edge of their consequences: we can know what we do, but René Descartes, to treat mind and body as distinct, separate cannot so readily know all of the eff ects of what we do. substances with no necessary links between them. Far from denying the reality of people’s distress, then, Second, we should recall that pain, such as that from a psychological explanations begin with this reality and attempt broken leg, is just as much ‘in the mind’ as distress, but we to understand how it has been constituted. In our view, PROOF 16 CONCEPTS only the existence of a cultural prejudice against psycho- focus of study will be what occurs inside the brain and body of logical explanations for distress prevents this from being more someone experiencing distress; other infl uences will only be obvious. important to the extent that they make a diff erence to the body and brain. Models also supply a mode of representation – an analogy Models of distress or set of metaphors that is useful for communication and conceptualization. In the cognitive model, for example, the In science, models are often used as an aid to thinking about analogy is that the mind works like a computer, so we conceive and researching problems. Formal scientifi c models are of distress as caused by faulty information processing. In this derived from theories and bear a systematic relationship to way, models also organize events and phenomena into (possi- them. There are also more ‘informal’ models that are most ble) causal chains. If distress is cognitive and arises because of accurately located within a paradigm rather than a theory, faulty information processing, the causal chains will implicate and these are the kind of models typically used in relation psychological mechanisms and strategies (attributions, percep- to distress. We have already mentioned biopsychosocial, tions etc.); if distress is biological, the causal chains will depend biomedical and psychosocial models of distress, but in the on biological phenomena such as features of the brain. literature many more are described. Figure 1.2 shows some of However, these benefi ts can also become limitations. the most commonly-cited models of distress, together with Because models are analogies or metaphors for distress, rather their most frequently used synonyms. than actual distress, they can easily be over-extended. Once Whilst for convenience we have named these models as we begin to think of distress in terms of (for example) a cogni- though they were separate and distinct entities, you need to tive model, we might be tempted to keep on thinking of it this be aware that in actual practice things are far more confusing. way even when we encounter aspects that might be better For example, it is possible to conceive of the diathesis-stress explained in other ways. For example, although some aspects model as a variant of the biopsychosocial model, because it of being extremely sad can be conceptualized cognitively (in attempts to unite biology, in the form of an organic vulnerabil- terms of a set of negative cognitive biases), other aspects are ity or diathesis, with the psychological and social infl uences probably better explained by reference to biological or social that cause stress. processes. This might seem to imply that a biopsychosocial However, it is equally possible to conceive of the diathesis- model is what is needed, and whilst in a superfi cial sense this stress model as a variant of the medical or psychiatric model, is obviously true, in practice most biopsychosocial accounts because it posits that clinical distress only arises in people who are inadequate (we discuss this issue in Chapter 4, especially are medically (biologically) vulnerable. Likewise, some family in Box 4.5). systems models are also psychoanalytic; and many psycho- Another possible disadvantage of using models is that, in logical models are cognitive as well as behavioural. Similarly, simplifying distress by focusing on what is most relevant from many people would see the biological model as being the a given perspective, they might actually leave out what is most same as the medical or psychiatric one, whereas some would important, but we will never know this unless we start from diff erentiate these. the actual phenomena (the experience of being distressed, in Using models to understand distress can yield a number of all of its complexity and confusions) rather than from within advantages. Models simplify complex issues, making it easier the bounds of a model to which we have already made an to think about them and to generate ways of researching them intellectual or professional commitment. empirically. They do this largely by selecting some aspects A fi nal disadvantage is that models of distress can be of distress as most relevant to enquiry, and others as less misleading with respect to causality because they might imply relevant: this assists with both theory and empirical research. sets of relations that, in actuality, do not exist. For example, Using a biological model of distress, for example, the primary 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 Biomedical (biological) levels of hormones also fl uctuate according to external infl u- ences such as social and relationship status. Medical (psychiatric, illness) There are also deeper conceptual issues with most commonly used models of distress because for the most part Diathesis-stress (stress-diathesis, stress-vulnerability) they accept boundaries that we might wish to question. For Behavioural example, biological and social infl uences tend to be either kept apart or – when they are brought together – mediated by Cognitive psychology. Whilst there is some sense in this, it then makes it Humanistic (existential) very diffi cult to consider situations where biological and social infl uences might interact directly, without necessarily being Psychodynamic (psychoanalytic) psychologically mediated, such as in the development of an embryo in the womb, or in the very early days of a human Family systems infant’s life. Psychosocial (sociocultural) Throughout this book we will sometimes have to make reference to models of distress, and you can use the table in Biopsychosocial this section to orient yourself toward them. However, whilst they can be useful, you should always bear in mind that they Figure 1.2 Models of distress can also be misleading. PROOF FROM DISORDER TO EXPERIENCE 17

Overview of this book diagnosis is not valid and reliable enough to provide a fi rm scientifi c basis for understanding distress. It then sketches an This book is in two parts. The fi rst part provides a foundation alternative, consistently psychological approach to classifying for the second by systematically setting out key concepts, distress. debates and evidence. The aim of the fi rst part is to supply a Causal Infl uences: In some instances, the causes of a detailed account of distress that describes its character, identi- person’s distress might seem quite obvious; in others, they fi es causal infl uences, and discusses responses to it. In the may seem mysterious or obscure. This chapter provides a second part, we apply this account of distress to a subset of the detailed discussion of the notion of causality in relation to most common kinds of mental health problems encountered distress, showing how it is often more diffi cult to ascertain and by professionals in clinical psychology, psychiatry, social work understand than we imagine. We describe and evaluate the and related disciplines. research methods used to establish causality in distress, and then review evidence showing that – regardless of the specifi c Part 1 form that distress takes –it is associated time and again with a common set of causal infl uences. This part contains eight chapters which, read together, provide Service Users and Survivors: Mental health service users a consistently psychological account of distress. Although we sometimes describe themselves as experts by experience. This frequently discuss psychiatric diagnoses in this part, we do chapter draws upon some of that expertise and describes how not use them as explanations. Instead, we off er explanations the service user movement in the UK has mounted a series of that draw upon psychological theories and concepts, supple- challenges to the treatments off ered by services. A discussion mented where appropriate with evidence and ideas from of the work of the ‘Hearing Voices Network’ shows how serv- disciplines including neuroscience, anthropology, sociology, ice users are continuing to challenge conventional services epidemiology and other relevant disciplines. In this way we by organizing themselves to provide viable alternatives to provide an account of distress that avoids ‘jumping ship’ and conventional therapies. uncritically importing wholesale a set of concepts and theories Interventions: Here we describe the kinds of interventions from psychiatry. Part 1 has eight chapters: for distress typically off ered by Western mental health services. We describe psychiatric medication, psychotherapy, and Introduction (this chapter) community psychology interventions, using these to show History how each off ers diff erent potential sources of help to people Culture experiencing distress. A number of diff erent mental health Biology professionals are involved in off ering interventions to people Diagnosis and Formulation in distress – in the appendix to the book we describe some of Causal Infl uences the key professional groups and the kinds of settings within Service Users and Survivors which they work. Interventions

History: To understand why we have the ideas we do today it Part 2 is vital to look at how those ideas were developed, so in this chapter we provide a survey of the diff erent ways that distress Part two of the book contains fi ve chapters. In each one has been understood and treated over the centuries. Our we discuss in detail one of the major kinds of distress that history shows how there have always been competing strands contemporary Western mental health services encounter. of explanation and treatment for distress, some primarily We had to make some diffi cult choices about how we should implicating the body and its organs and some primarily impli- present this material. On the one hand, we did not want to cating experiences, meanings, thoughts and feelings. organize the material around psychiatric diagnoses. On the Culture: This chapter describes how distress diff ers between other hand, we knew that many mental health modules are cultures. It discusses some of the great variability in the forms structured in this way. This meant that we needed to present of distress, the variability in the ways that it gets linked to other our material in a way that was useful to as many people as aspects of experience, and the variability in the outcomes possible. associated with it. As we have already suggested, distress is We have done this by structuring these chapters around thoroughly bound up with culture, and this chapter illustrates broad forms of distress where there is some commonality in the extent and consequences of this. the underlying phenomenology of an experience. In psychol- Biology: Our approach to biology treats it as an inescapable ogy, phenomenology refers to exactly what an experience is part of distress, but does not make the unfounded psychiatric like – what kinds of characteristics, features and subjective assumption that it is always the ultimate cause of people’s qualities it has. Refl ecting some of its links with philosophy diffi culties. In this chapter we explain why there are problems (phenomenology is also an important branch of philosophy), with biopsychosocial accounts of distress, and in their place this usually means that eff orts are made to include the bodily off er an alternative view of the role of biology. We summarize or embodied aspects of experience, as well as those usually evidence that supports our approach, drawing upon studies described as mental or cognitive. of attachment as well as upon recent work in psychology and What does this look like in practice? Well, for example, it neuroscience. means that Chapter 9, ‘Sadness and Worry’, deliberately treats Diagnosis and Formulation: Textbooks of ‘abnormal together aspects of experience that are usually treated sepa- psychology’ are usually organized around systems of psychi- rately in books organized according to the DSM classifi cation. atric diagnosis, such as one of the versions of the DSM. In other books, these experiences are likely to be addressed This chapter presents some of the evidence that psychiatric in two separate chapters, one focused upon ‘Depression’ and PROOF 18 CONCEPTS the other focused upon ‘Anxiety Disorders’. Similarly, Chapter will get a lot more out of reading all of them if you fi rst read the 11 on ‘Madness’ includes experiences that, in other textbooks, chapters in Part 1. would be addressed separately in relation to psychiatric diag- noses such as schizophrenia and bipolar disorder. Questions Although the number of diff erent kinds of distress we Each of the chapters has a set of questions associated with it. discuss in this way is fairly small, they will account for the vast You can use these questions to check your own learning and majority of the referrals received by UK mental health services. make sure that you understand the material in the book in the The chapters are way that we intend. There are guiding questions at the start of Sadness and Worry each chapter that will alert you to recurrent themes to keep in Sexuality and Gender mind as you read. There are also summary or revision ques- Madness tions at the end, which you can use to check that your learning Distressed Bodies and Eating is proceeding adequately. Disordered Personalities

Each of these fi ve chapters is structured in a similar way, and Boxes each one builds upon the concepts and evidence laid out in All through the book we use boxes to introduce additional Part 1 of the book. Within each of these chapters there are material alongside the main text. Some of the boxes simply sections on history and culture, a summary of the psychiatric contain material that, although linked to the main text, is easier diagnoses typically given to people experiencing this form of to explain separately. Other boxes contain discussions of key distress, a review of the evidence regarding causality, and a theories, concepts or issues which will recur throughout the description of the kinds of treatments and interventions avail- book. able for this kind of distress. Key terms and concepts How to use this book You have probably already noticed that whenever we use any specialist terms or language for the fi rst time, the term is Sequence printed in bold and a defi nition or explanation appears very close by – mostly immediately afterwards, occasionally just Because most ‘abnormal psychology’ textbooks are structured beforehand. around the diagnostic categories of the DSM, they often do not make a sequential, structured argument. This means that it is Stories and experiences usually quite easy to dip into them, regardless of the order of the chapters, in order to read about specifi c diagnoses. Almost all of the chapters in this book start with a story about This book is a little diff erent. In Part 1, especially, all of the someone’s experience. As we have already explained, these chapters are linked so that together they provide a systematic stories are all fi ctional but, at the same time, they are informed argument that explains our approach to distress. The chapters by clinical practice and by close readings of the mental health in Part 2 are more like the chapters in other textbooks, in that literature. You can read them as a very quick and accessible it does not especially matter in which order you look at them. way of orienting yourself to the concerns and issues that each However, whilst these chapters can be read in isolation, you chapter raises. PROOF 409

INDEX

Note: Page numbers in bold refer to defi nition/concept; Page numbers in italics refer to fi gures; Page numbers followed by “b” indicate boxed material; Page numbers followed by “t” indicate tables.

AA, see Alcoholics Anonymous intrapersonal and interpersonal causal in Germany, extermination programmes, Abnormality, see normality and abnormality factors, 296 39–40 abnormal psychology, 11–12 psychiatric diagnosis of, 289 Hanwell Asylum (London), 30, 33 Abrahamson, L., Seligman, M. & Teasdale, J. antidepressants, 166–7 Lincoln asylum (England), 30 cognitive theory of sadness and worry, atypical, 214 maristans, 23b 205–6 eff ectiveness of, 213b professionalization of management, 30–1 Academy of Gundishapur, 23b and sexual problems/dysfunction, 230 state responsibility of, 30 acceptance and commitment therapy, 176 see also tricyclic antidepressants Asylum: A Magazine for Democratic accidie, 26, 195, 196 anti-histamines, 43, 161, 164 Psychiatry, 52 acculturation, 73 anti-psychiatry, 4, 12–13, 47–8 Asylum Journal, 30 types of, 73 coinage of term, 48 attachment theory, 37 ACMD, see Advisory Council on the Misuse decline of, 50 role in distress, 128–9, 272 of Drugs and growth of service user action, 144 Schore’s, 95–8 Addington, Anthony, mad-doctor, 28 antipsychotics, 43, 159, 160, 161, 164–5 Schore’s, limitations of, 97b ADHD, see attention defi cit hyperactivity eff ects of, 162, 165–6 attention defi cit hyperactivity disorder disorder effi cacy of, 164, 276 (ADHD), 67b Adler, A., 178, 310 second-generation, 165, 276–7, 306 psychiatric medication for, 167 adoption studies, 81 antisocial personality disorder (APD), 309 attributional style eff ects, 205–6 on eating disorders, 297, 298–9 childhood antecedent of, 323 atypical antidepressants, 214 on psychosis diagnosis, 263, 268 dangerousness and treatability of, 337 atypical antipsychotics, 165–6, 276–7 Advisory Council on the Misuse of Drugs gender bias in diagnosis of, 327–8 and weight gain debates, 306 (ACMD) (UK) interventions for, 336–8 auditory hallucinations, see voice-hearing cannabis use and schizophrenia study, see also borderline personality disorder Avicenna (Ibn Sina), 23b 85–6, 87 anti-stigma campaigns, 7 advocacy, service user/survivor-led, 147 ‘Changing Minds: Every family in the land’, Basaglia, F., 46, 49 African-Caribbean community in UK 111 Battie, W. and compulsory treatment, 170 anxiety disorders diff erentiation of types of madness, 29 interventions for psychiatric diagnosis, 134 in children, 204 Bayle, A. L., 34, 251 schizophrenia among, 72–3, 133 in women, 195, 198 Beck, A. age see also generalized anxiety disorder; cognitive theory of depression, 43, 49, 207, causal role in sexual problems/dysfunction, sadness and worry 254–5, 278 228 APA, see American Psychiatric Association; Becker, H. agoraphobia, 197 American Psychological Association notion of “moral entrepreneur”, 30 Alcock, C., 181 APD, see antisocial personality disorder Bedlam, 22 Alcoholics Anonymous (AA), 46 approved mental health professionals, 169, in popular culture, 28 alexithymia, 297 339 see also Bethlem Royal Hospital alienists, 30, 34 Aretaeus of Cappadocia Beers, C. Alleged Lunatics’ Friend Society, 22, 139 on melancholy, 24 A Mind that Found Itself, 22–3 American Psychiatric Association (APA), 44 Association of Medical Offi cers of Asylums behavioural disinhibition, 329 see also Diagnostic and Statistical and Hospitals for the Insane (UK), 30 behavioural genetics, 78–81 Manual of the American Psychiatric see also Royal College of Psychiatrists see also molecular genetics Association Association of Medical Superintendents of behaviourism, 37–9, 42, 174 American Psychological Association (APA) American Institutions for the Insane, behaviour therapy, 42, 174 on electro-convulsive therapy, 275 30 for sadness and worry, 216 membership growth, 45 see also American Psychiatric Association third wave therapies, 176 amphetamine, 167 asylum(s), 20 Benedetti, G., 277 analogue experiments, 125 in 16th-18th century, 28–9 Bentall, R., 50 anger/rage in 16th-18th century, modes of intervention, cognitive account of sadness, 206 and brain development association, 96–7 29, 30 on Kraepelin’s diagnostic classifi cation, 35 causal role in eating disorders, 297 in 18th-20th century, abuses and reforms ‘Whig’ historical writing, 21b see also emotions of, 31–2 benzodiazepines, 168, 214 anorexia nervosa, 285 in 19th century, 30 Berkson’s bias, 260 and cognition, 296 in 19th century, admissions and discharges, Bethlem Royal Hospital (London), 22, 195 DSM criteria for, 286b 32–4 750th anniversary of, 151b Gull conceptualization of, 286 decline of, 44 in popular culture, 28 PROOF 410 INDEX

binge eating disorders, 285 Boyle, M., 50 causality in distress, 35, 89b and cognition, 296 on Kraepelin and Bleuler’s description of and clinical practice, 136–7 cognitive maintenance model of, 297 schizophrenia, 35–6 consequential madness, 29 DSM criteria for, 286b on problems in the use of the term controversies about, 134b psychiatric diagnosis of, 289 ‘psychosis’, 255b family’s role, 42–3, 127–8 biological causation of distress, 76–81, 129–31 BPS, see British Psychological Society nature of, 120–1 and clinical practice, 136 Bradley, B. necessary causes, 78b, 121 in context, 81–4 on contingency, complexity and chance, public opinion about schizophrenia of eating disorders and weight concerns, 122 causality, 256 297–8 brain, 77 recognized kinds of, 127–37 irrelevance thesis, 84–91 abnormalities of, causal role in distress, 130 research diffi culties, 124 of personality disorders, 331–2 body-brain system, 92–3 research methods for studies on, 124–7 of sadness and worry, 208–11 hemispheric activation and experiences of in sadness and worry, 201–5 of sadness and worry in women, 203 sadness, 209 social and cultural dimensions, 119–20 of schizophrenia, 262–4 imaging studies of, 265 suffi cient causes, 78b, 121 of sexual problems/dysfunction, 230–1 and schizophrenia association, 263–4 see also biological causation of distress; biological psychiatry social and environmental infl uences on culture; gender; genetics; relational foundation of, 33–4 development of, 93–5 causation of distress; social causation rise of, 34–6 brain fag (culture-bound syndrome), 67b, of distress biomedical model of distress, 7, 8, 76, 136 198 CBD, see cannabidiol and attitudes association, 256–7 brainwashing, 40 CBT, see cognitive behavioural therapy resurgence in 1970s and 1980s, 50 Breggin, P. R. Central Intelligence Agency (CIA) (US) see also biological causation of distress Toxic Psychiatry, 50 interrogation methods and psychiatry use, bipolar disorder, 250 Breuer, J., 10b, 37 40 DSM-IV criteria for, 258 Brewin, C. ceremonial histories, 21b psychiatric medication for, 167 dual representation theory, 210–11 Cerletti, U., 39, 275 see also manic depression Briggs, K. 310 Cervantes, Miguel de. Don Quixote, 27, 28 biopsychosocial model of distress, 4–5, 91, Briggs-Myers, I., 310 CFS, see chronic fatigue syndrome 262 British Psychological Society (BPS), 83, 120 Chamberlin, J., 50 problems of, 91b membership growth, 45 On Our Own: Patient Controlled Bleuler, E., 102, 275 Bronfenbrenner, U. Alternatives to the Mental Health notion of schizophrenia, 35–6, 251–2, ecological model of systems, 182 System, 51, 144 253 Brown, G. W. & Harris, T. O. Chesler, P. on schizophrenia causality, 253 studies on social inequalities and distress in Women and Madness, 21b Bleuler, M., 260 women, 132 Chiarugi, V., Italian physician, 29 Board, B. J. & Fritzon, K. bulimia nervosa, 285 childhood abuse and trauma notion of psychopathic personality causality in, 292, 295, 297, 298 and attachment theory, 95–9, 128–9 disorder, 325 and childhood sexual abuse, 292, 295 causal role in personality orders, 328–30 body, 15, 20, 23b DSM criteria for, 286b causal role in psychosis, 268–9, 274 anatomists’ conceptualization of, 26 interventions for, 302–3 causal role in sadness and worry, 205, and gender variance, 243–4 prevalence of, 290 211–12 and sexual identity, 222 psychiatric diagnosis of, 289 causal role in sexual problems/dysfunction Western and Eastern perspectives, 69–70 Burton, R. later in life, 231–2 body-brain system, 92 Anatomy of Melancholy, 195, 196 and dissociation, 272 external infl uences on, 92–3 and traumagenic neurodevelopmental see also mind-body dualism Cameron, E. model of psychosis, 271 body dissatisfaction ‘depatterning’ technique, 40 see also sexual abuse in childhood and eating disorders and weight concerns, cannabidiol (CBD), 86–7, 88 China 291–2 cannabis, 86 epigenic eff ects study, 92b body image illegal drug classifi cation in UK, 85 neurasthenia diagnosis, 71, 196–7 causal role in eating disorders and weight early heavy use of, and psychotic political abuse of psychiatry, 41 concerns, 290–2 experiences, 269–70 prevalence of clinical depression, 58 and prevalence of eating disorders, 288 and schizophrenia association, 85–8 chlorpromazine, 43, 164–5 Western perspective, 284, 285, 287 cannabis psychosis, 267 Christianity body image distortion, 291–2 Caplan, P. faith healers connected with, 59b body weight issues, see eating disorders and notion of delusional dominating view of madness, 25–6 weight concerns personality disorder, 109, 328 chronic fatigue syndrome (CFS), 196, 197 borderline personality disorder, 309 Care Services Improvement Partnership see also neurasthenia causality in, 329–30 (CSIP)/Shift, 8 Churchill, W., 39, 47 cultural bias in diagnosis of, 324–6 Cartesian dualism, see mind-body dualism CIA, see Central Intelligence Agency diagnostic criteria for, 106 Cartwright, S. A. circadian rhythms diagnostic issues, 317 on ‘disorder’ peculiar to negro slaves, 34b causal role in sadness, 209–10 gender bias in diagnosis of, 327–8 case study research cisgender, 223, 242–3 interventions for, 333–6 on causality in distress, 126–7 Clare, A. W. and self-harm, 329b Cassel Hospital (London), 335 Psychiatry in Dissent, 50 see also antisocial personality disorder categorical models of diagnosis, 4, 261–2, classical conditioning of refl exes, 38 Boskind-Lodahl, M. 321–3 in phobias, 202b, 206–8 on self-esteem and eating disorders Cattell, R., 310 client-centred therapy, 42 association, 293 causal attributions, 119 clients/consumers, see service user/survivor(s) PROOF INDEX 411

clinical psychologists, 339 Cooper, M. Locke’s view of, 27 clinical psychology cognitive maintenance model of binge prevalence of, 257 vs. community psychology, 182t eating, 297 dementia praecox, 35–6, 252 growth of, 44–5 correspondence bias, 119 Deniker, P., 165 professional culture of, 58 cosmetic surgery depatterning, 40 and schizophrenia, 253–5 and enhancement of self-esteem and depression clothing sexual pleasure, 222 biological causation thesis, 76–7 and gender variance, 243 Costa, Jr., P.T. & McRae, R. R. culture-specifi c forms and diagnosis of, 71 cognitive analytic therapy, 136, 334 fi ve factor model of personality, 310, 312b vs. melancholy, 196 cognitive behavioural therapy (CBT), 43, 61, 174 cothymia, 200 psychiatric diagnosis of, 200 for antisocial personality disorder, 337 Cotton, H., 39 psychiatric medication for, 166 for eating disorders and weight concerns, counselling psychologists, 339 Descartes, R. 301–3 counsellors, 339 mind-body dualism, 15, 26–7, 69 number needed to treat (NNT) criterion countertransference, 333 Determinants of Outcome of Severe Mental for, 189 Creative Routes (group), 151b Disorder (DOSMed), 64–5 practitioners of, 177 crime, see violence and crime Deutsch, A. for psychosis, 278–9 Cristal, R. & Tupes, E. Shame of the States, 44 for sadness and worry, 215–16 fi ve-factor model of personality, 310 diagnoses, see medical diagnoses; psychiatric for sexual problems/dysfunction, 230–1 Cromby, J. diagnoses cognitive psychology notion of transactional scripts, 207b Diagnostic and Statistical Manual of the downplay of biological causation of Crow, T. American Psychiatric Association (DSM), distress, 84–5 two factor model of schizophrenia, 260 5b, 47, 103 cognitive research CSIP/Shift, see Care Services Improvement changes in diagnostic categories, 47 on eating disorders and weight concerns, Partnership/Shift dimensional assessment approach 295–6 CTO, see community treatment order proposal, 111, 112b on psychological mechanisms involved in Cullen, W., professor of the institutes of eating disorder category, 285 psychosis, 272–4 medicine, 27 notion of delusion, 261b cognitive therapists, 339 cultural identity notion of gender variance, 242b cognitive therapy, 43, 174 signifi cance in psychosis development, 72–3 paraphilias category, 220, 238–9 collectivist societies see also ethnicity/ethnic groups personality disorder category, 314, 315t selfhood in, 59 culture, 56–7 personality disorder category, criticism of, view of somatization, 70–2 and biological causation of distress, 82 315–16, 319–20 Colney Hatch Lunatic Asylum (London), 33 consumer culture, 60b sexual deviation category, 47, 221–2 communication deviance, 268 cross-culture perspectives of psychiatric sexual problems/dysfunction categories, community care, 44 diagnosis, 108 226b in UK, success/failure of, 46 and defi nitions of normality, 61–2 task force on culture, 58 community psychology, 137, 179, 180–1 and eating disorders/weight concerns, see also psychiatric diagnoses eff ectiveness of, 182–4 287–9, 290–7 Diagnostic and Statistical Manual of the interventions, 184–8 and experiences of distress, 9–10, 255–6 American Psychiatric Association, fourth theoretical framework of, 181–2 and experiences of sadness and worry, edition (DSM-IV), 58 community treatment order (CTO), 147, 169 196–8 bipolar disorder and schizophrenia co-morbidity, 106–7 and large-scale institutionalization, 33 construct, 258 clarifi cations in DSM-5, 112b and personal agency, 135–6 culture-bound syndromes, 66 in DSM-III schizophrenia, 260 and personality, 312–13 defi nition of mental disorder, 13b in personality disorders, 320–1 and personality disorders, 323–6 descriptive assessment approach, 111 compulsory psychiatric treatment, 159, 168–9 and schizophrenia, 64–5 gender identity disorder construct, 244b, campaign against (Kiss it!), 151b, 185 and self, 59–61 245–6 ethical dilemmas, 169 and sexuality, 222 Global Assessment of Functioning Scale opposition to, 147–8 and sexual problems/dysfunction, 227–8 (GAF), 261 recipients of, 170 Western vs. non-Western societies, 58–9 list of paraphilias, 239b rise in use of, 171 culture-bound syndromes, 66–7, 108 Organic Mental Disorders category, 104 ‘sectioned’, 56, 169 eating disorders and weight concerns, 287 personality disorder construct, 312–13, 315t concordance (genetics), 78–9 of sadness and worries, 197–8 personality disorder construct, revisions studies, 79–81 of, 322b conduct disorder, 323 Damasio, A. R. Sexual and Gender Identity Disorders biopsychosocial model of, 332 somatic marker hypothesis, 207b category, 221 diagnostic criteria for, 106 dangerous and having a ‘severe personality Sexual Disorders Not Otherwise Specifi ed Conolly, J., English physician, 30 disorder’ (DSPD), 337 category, 222 consequential madness, 29 Davenport, C., eugenicist, 39 see also psychiatric diagnoses consumer evidence, 144, 148 DBT, see dialectical behaviour therapy diagnostic categorization, 46 contingency decompensation, 67 1900–1945, 34–6 and causality in distress, 121–4 degenerationist theories, 33, 39 alternative approaches to, 261–2 control (over one’s life) de-institutionalization, 22, 46 modern attempts at, 46–7 causal role in eating disorders, 288, 290–1, in UK, 44 pharmaceutical companies’ infl uence on, 292–3, 295 delusions, 6, 10b 43–4 conversion (reorientation/reassignment) cognitive research on, 273 for schizophrenia, reliability and validity therapy, 224 content of, and childhood abuse issues, 259–61 Cooper, D., 144 association, 269, 270b dialectical behaviour therapy (DBT), 176 Psychiatry and Anti-Psychiatry, 48 debates about, 261b for borderline personality disorder, 334–5 PROOF 412 INDEX

diathesis-stress model , 16, 34, 76, 254 DSM, see Diagnostic and Statistical Manual of of social interventions for borderline of schizophrenia, 262–3 the American Psychiatric Association personality disorder, 335 dichotic listening, 206 DSPD, see dangerous and having a ‘severe electro-convulsive therapy (ECT), 39, 171–2, DID, see dissociative identity disorder personality disorder’ 214–15, 275–6 dieting, 284, 291, 292–3, 302 dual representation theory, 210–11 Ellis, A. see also starvation dysaesthesia aethiopica, 34b rational therapy, 43 dimensional models of diagnosis, 4 dysfunction, 13b emic knowledge, 61 of personality disorders, 321–3 dyspareunia, 226 emotions of psychosis, 261–2 causal role in eating disorders and weight discrimination early maladaptive schemas, 331 concerns, 296–7 as consequence of paraphiliac behaviours, eating disorders and weight concerns, 285 causal role in sexual problems/dysfunction, 241 causality in and maintaining factors of, 229 as consequence of psychiatric diagnosis, 290–300 and culture, 62 110 and economic growth association, 60b see also sadness and worry and gender identity, relation with distress, gendered phenomena, 291, 292–4 emotion work, 203 223–4 historical and cultural context of, 286–8 empowerment, 146–7, 150–1, 182, 279–80 service user/survivor’s campaigns against, interventions for, 300–6 of people with learning disabilities, 186–7 149–50 psychiatric diagnosis of, 109, 289–90 encephalitis lethargica, 35–6 service user/survivor’s liaison with media Western forms of, 285–6 endogenous opioids, 298 on, 146 eating disorders not otherwise specifi ed England service user/survivor’s opposition to, 142 (EDNOS), 285 care of insane in 16th-18th century, 28 and stigma, 7–9 DSM criteria for, 286b compulsory treatment, 169–71 disease-centred model of drug action, 160, psychiatric diagnosis of, 289 increase in number of patients in 19th 164, 168 Eberl, I., 39 century, 33 disorganized attachment relationship, 95–7, ecological model of systems, 182 non-restraint practices in 19th century, 30 99 ECT, seeelectro-convulsive therapy psychiatric diagnosis in, 63b dissociation, 66 EDNOS, see eating disorders not otherwise Time to Change campaign, 149, 150 association between psychosis, trauma specifi ed see also United Kingdom and, 272 EE, see expressed emotion environments/environmental infl uences, 80b cultural construction of, 66 EEA, see equal environment assumption on brain development, 93–5 and early relational trauma, 95–7 effi cacy and eff ectiveness, 189 and genes, 76 and religious experiences, 68 of antidepressants, 213b Rose’s lifelines model, 76, 88–92 Western diagnostic criteria of, 67 of anti-psychotics, 164, 275–7 twin studies, 79–81 dissociative identity disorder (DID), 66 of cognitive analytic therapy for borderline see also interpenetration in US, 67–8 personality disorder, 334 epidemiology/epidemiological studies, 60 distress, 9–11 of cognitive behavioural therapy for eating of cannabis use and schizophrenia association between eating disorders and disorders and weight concerns, diagnosis, 87 other forms of, 299 302–3 of causality in distress, 126 causal infl uences, see causality in distress of cognitive therapy for psychosis, 278–9 of social inequalities, 132–3 developments in classifi cation of, 34–6 of community psychology, 182–4, 185 WHO’s cross-cultural study of experiences of, 9–11, 13, 14–15 of early intervention for psychosis, 279 psychological problems, 62–3 expressions of, 66 of electro-convulsive therapy, 172, 275 epigenics, 92, 92b, 131 as a form of mental illness, 20, 57–8 of family therapies for eating disorders and equal environment assumption (EEA), 80, 263, ‘in between, just short of, and left over’ weight concerns, 304 298 categories of, 107 of medication for antisocial personality Esquirol, J.-É. Islamic approaches to, 23b disorder, 337–8 Mental Maladies, 34 problem of thresholds, 10b of preventative interventions for antisocial ethics psychological perspective of, 15–16 personality disorder, 336–7 of compulsory treatment, 169, 189 terminology, 6 of preventative interventions for borderline of force-feeding, 301 see also eating disorders and weight personality disorder, 335 of physical interventions for sadness and concerns; madness; personality of psychiatric medication for borderline worry, 214–15 disorders; sadness and worry personality disorder, 336 ethnicity/ethnic groups divination, 58 of psychiatric medication for eating causal role in distress, 133–4 in Zambia, 59b disorders and weight concerns, compulsory treatment for, 170 Dix, D., American social reformer, 30 304–6 and psychiatric diagnosis association, 72–3, Dodge, K. A. & Petit, G. S. of psychological interventions for antisocial 108 biopsychosocial model of conduct personality disorder, 337 and schizophrenia diagnosis association, disorder, 332 of psychosocial interventions for psychosis, 267 domestic violence 277–8 etic knowledge, 61 causal role in distress, 129 of psychotherapies, 174–6 eugenics, 33 in heterosexual couples, 328 of psychotherapies for sadness and worry, and Nazi genocide, 39–40, 275 victims of, 133, 203 217b proponents of, 39 see also violence and crime of schema-focused therapy for borderline experiences dopamine hypothesis of schizophrenia, 76, 77, personality disorder, 334 and biology, 76 99, 264–5 separated vs. conjoint family therapy, 304 and culture, 60–1 DOSMed, see Determinants of Outcome of of service-level interventions for borderline enabling vs. causing of, 89b Severe Mental Disorder personality disorder, 336 perspectives on, 13–14 drapetomania, 21b, 33, 34b of Sex Off enders Treatment Programme phenomenology of, 17–18 drug-centred model of drug action, 160–1, 168 (SOTP), 241b experiences of distress, 9–11, 13, 14–15 PROOF INDEX 413

experiences of service users/survivors free association, 37, 173 Goff man, E. redefi nition of, 142–3 Freeman, W. Asylums: Essays on the Social Situation of experimental research method psychosurgery technique, 43 Mental Patients and Other Inmates, for causality in distress studies, 124–6 Freire, P., 188 48 expressed emotion (EE), 65, 268 notion of conscientization, 188 Stigma: Notes on the management of high EE, 128 Freud, S., 10b, 20, 253, 271, 310 spoiled identity, 7 Eysenck, H., 310 psychoanalytic techniques of, 37, 173 Gottesman, I., 79–80 Friends of Insane Persons, 22 Green Belt Movement (Kenya), 184 Fairburn, C. functional diagnoses, 78 Griesinger, W., 34 transdiagnostic approach to eating functional redundancy, 98 Gull, W. disorders and weight concerns, fundamental attribution error, 119 conceptualization of anorexia nervosa, 301–3 286 Fallon, J. GABA, see gamma-aminobutyric acid GWAS, see genome-wide association on genetics role in personality disorders, Galen of Pergamum, 24 studies 332–3 gamma-aminobutyric acid (GABA), 214 family causal role in experiences of worry, 210 Hage, P., 50, 152 causal role in distress, 42–3, 127–8 gay affi rmative therapies, 224 hallucinations, 6 causal role in eating disorders, 299 gay liberation movement, 47 cognitive research on, 272–3 causal role in personality disorders, 328–30 Gazzaniga, M. S. content of, and childhood abuse causal role in sadness and worry, 203–4 research with split-brain patients, 93 association, 269, 270b childhood abuse and sexual problems/ gender fi ctional representation of, 28 dysfunction, 228–9 causal role in distress, 133 prevalence of, 262 and expressed emotion, 65 causal role in personality disorders, 326–8 Hanwell Asylum (London), 30, 33 parental absence and psychosis causal role in sadness and worry, 203 Harper, D. development, 72–3 childhood abuse and sexual problems/ on debates about delusions, 261b parental absence and schizophrenia dysfunction, 232 Hartley, J., 169 diagnosis, 267 and eating problems and weight concerns, Having a Voice (Manchester: organization), and schizophrenia diagnosis association, 291, 292–4 146 267–8 and learning disabilities, 186 healers, 58, 59b, 69 temporal specifi city and distress, 95–8 and sex, 222–3 shamans, 61–2, 69 family studies, 81 and sexual problems/dysfunction, 228 hearing voices, see voice-hearing on schizophrenia, 262–3 see also sexuality Hearing Voices Network (HVN), 70b, 145, family therapies, 42–3 gender identity, 221, 247 152–5, 280 for borderline personality disorder, 335 and discrimination, relationship to distress, Henderson Hospital (Sutton), 335 vs. cognitive behavioural therapy for eating 223–4 heritability (h2) index, 80b disorders, 303 gender identity disorder, 221 heteronormativity, 247 for eating disorders and weight concerns, in children, diagnostic criteria, 246b Hickling, F., 72 303–5 diagnostic criteria issues, 243b, 244–6 Hill, R. G., English physician, 30 systemic approaches, 179 gender reassignment surgery/sex Hippocrates, 24 Fanon, F. reassignment surgery, 243, 246–7 ‘On the disease of young women’, The Wretched of the Earth, 48 diagnostic criteria issues, 245 286 feminist family therapy gender variance history of distress, 19–54 for eating disorders and weight concerns, and body, 243–4 of eating disorders and weight concerns, 304 and distress, 242b 286–7 Fenichel, O., 178 terminology and concepts, 242–3 of personality disorders, 309–10 fi rst person narratives, 21–4 see also gender identity; transgender of personality theory and its problems, fi ve-factor model of personality, 310–11, 312b generalized anxiety disorder, 198 310–12 fl ashbacks, 199, 210–11 and life events, 204 of psychiatric diagnosis, 102–3 see also post-traumatic stress disorder psychiatric diagnosis of, 200 of psychiatric diagnosis of personality fl ooding, 216 psychiatric medication for, 214 disorders, 314 fl uoxetine, 214 and social inequality, 201–2 of sadness and worry experiences, formulation, 102, 114 general paralysis of the insane/syphilis, 31 195–6 for eating disorders, 301 genetics of schizophrenia, 35–6, 251–3 limitations of, 115–16 causal role in distress, 78–81, 130–1 of sexuality, 221–2 and psychiatric diagnoses, 115 causal role in distress, 18th century views, Hogarth, W., 28 for psychosis, 280–1 29 Holland, S. purposes of, 114–15 causal role in eating disorders, 297 notion of social action therapy, 187–8 see also psychiatric diagnoses causal role in personality disorders, 332–3 Holmes, G., 184 Foucault, M., 27 causal role in sadness and worry, 211 home care Folie et Déraison: Histoire de la Folie à causal role in schizophrenia, 262–3 in 16th-17th century, 28 l’Âge Classique, 28–9, 48 causal role in sexual problems/dysfunction, in developing countries, 65 Foundation Resonance (Stichting Weerklank) 231 homosexuality (Netherlands), 50, 70b gene, 90b psychiatric view of, 47, 221–2 France see also lifelines: Rose’s model of Hopi people developments in classifi cation of distress, genome-wide association studies (GWAS), 81 sadness amongst, 197 34 German psychiatry hormones homogenization of insane, 28–9 classifi cation of distress, 34–5 causal role in sexual problems/dysfunction, Napoleonic Code, 32 and Nazi genocide, 39–40 231 psychiatric diagnoses, 63b glossolalia (speaking in tongues), 68 Horney, K., 178, 310 PROOF 414 INDEX

hospitals for Black, minority and ethnic groups, 134 Kleinplatz, P., 238, 239, 241 in 16th-18th century, 28 for child sex off enders, 240b–1b Knight, T., 169 in 1950s-1960s, 45b early intervention, 279 Kohut, H., 310 Cassel Hospital (London), 335 for eating disorders and weight concerns, koro (culture-bound syndrome), 67b de-institutionalization, 46 300–6 Kraepelin, E., 275, 310 Henderson Hospital (Sutton), 335 for gender variance, 243, 245, 246–7 classifi cation of distress, 35, 102, 103, 252–3 Pilgrim State Hospital (Brentwood, US), 44 guidelines for borderline personality conception of schizophrenia, 35–6, 251–2 St. Elizabeth’s Hospital (Washington, DC), 48 disorder, 334, 335, 336 study of psychosis in Java and Europe, 62, 70 Tavistock Clinic (London), 37 incorporation of causal infl uences, 136–7 on symptoms and outcomes of Winwick Hospital, (Warrington, England), for madness, 274–81 schizophrenia, 253, 254b, 260–1 33, 45b ‘moral’ (psychological) methods, 29–30 Kraff -Ebing, R. see also asylum(s) for personality disorders, 333–8 categorization of sexuality, 223b HSRC, see human sexual response cycle post-1945, 42 Huber, W., 53b for sadness and worry, 212–17 labelling theory, 48 human activities service user/survivor involvement in, 146–7 Laing, R. D., 12, 107, 127–8, 144, 178 enabling and causal infl uences, 90–1, 122 for sexual problems/dysfunction, 234–7 The Divided Self, 47–8 role of language in, 92–3 see also community psychology; language humanistic and existential psychotherapies, compulsory psychiatric treatment; role in human thinking and actions, 92–3 42, 174 effi cacy and eff ectiveness; language of distress, 5–6, 107–8, 111 practitioners of, 177 physical interventions; psychiatric championing of new terminology, 142–3 human sexual response cycle (HSRC), 225 medication; psychological therapies/ new terminology, 140b humoral model of distress, 21, 24–5, 26 psychotherapies Lasegue, C. HVN, see Hearing Voices Network introspection, 37 on wasting diseases, 286 hypervigilance, 72 IPSS, see International Pilot Study of Latin America hypnotism, 37 Schizophrenia community psychology, 180 hysteria, 37 Islam law and legislation on mental health (France), 32 and gender association, 21b, 221 holistic view of distress, 23b, 27 law and legislation on mental health (UK) ISOS, see International Study of Schizophrenia 18th-20th century, 31, 32 ICD, see International Classifi cation of ISPS, see International Society for 1983-2007, 53t Diseases Psychological and Social Approaches to on compulsory treatment, 44 imaging techniques Psychosis Medical Act of 1858, 31, 32t in neuroanatomy and biochemistry studies, Italy Mental Health Act, 1983, 337 264–5 de-institutionalization, 46 Mental Health Act, 2007, 142, 147–8, 159, incidences, 56 increase in number of patients in 19th 169, 337 of schizophrenia, 64, 131 century, 33 law and legislation on mental health (US), 51 of somatization, 70–1 learning disabilities individualism, 58, 59 Jahoda, M., 180 empowerment of people with, 186–7 infantile sexuality, 37 James, W., 310 Leary, T. Ingleby, D., 178 Japan interpersonal circumplex model of, 310, 311 inner speech, 93 eating disorders, 60b, 288 Lee, S. Institute of Psychiatry (London), 86, 149 ‘fox possession’, 61–2 on association between control and eating institutionalization incidences of somatization, 71 disorders, 288 and asylum system, 32–4 taijin kyofusho syndrome, 61, 197, 198 legitimacy of psychiatry insulin coma therapy, 39 Jaspers, K. and diagnostic classifi cation, 35, 103–4, integrated formulation, 114 psychiatric diagnostic classifi cation of, 102–3 108–9 integrated model of distress, 137–8 Jaynes, J. post-war period, 46 International Classifi cation of Diseases (ICD), notion of bicameral mind, 152 lesbian, gay, bisexual, transgender, queer and 5b, 47, 103 jinn (culture-bound syndrome), 67b questioning (LGBTQQ) personality disorder category, 314, 315t Johnson, V., see Masters, W. & Johnson, V. gay men and sexual problems/dysfunction, prevalence of most common ICD-10 Joseph, J., 79–81 233b diagnoses, 62–3 Jung, C., 37, 103, 271 liberation movement, 47 proposal for dimensional assessment and mental distress, 223–4 approach, 111 Kagan, C. see also gender identity; transgender International Pilot Study of Schizophrenia on temporal plasticity, 99 LGBTQQ, see lesbian, gay, bisexual, (IPSS), 64, 65 Kaya House (weekend crisis resource) transgender, queer and questioning International Society for Psychological and (London), 146 Liddie, P. Social Approaches to Psychosis (ISPS), kayak-angst (culture-bound syndrome), 197 on psychotic symptoms, 260 277 Kemberg, O. life events International Study of Schizophrenia (ISOS), transference-focused psychotherapy, 334 adversity and psychosis association, 64, 65, 260 Kempe, M. explanatory models, 271–4 interpenetration, 76 fi rst person narrative of distress, 22 adversity and schizophrenia diagnosis body and social infl uences, 92–3 Keseys, K. association, 267–71 genes and environmental infl uences, 89–91 One Flew Over the Cuckoo’s Nest, 48 causal role in eating disorders and weight the interpreter, 93 Kiesler, D. J., 310 concerns, 295 interventions, 158–90 Kingsley Hall (London), 48 causal role in personality disorders, 330 17th-19th century, 27, 28, 29–30 Kinsey, A., 223b causal role in sadness and worry, 204 in 18th century asylums, 29 Kleinman, A. causal role in sexual problems/dysfunction, 1900-1945, 34–6 diagnosis of neurasthenia, 71, 196–7 229 PROOF INDEX 415

lifelines, 76 Media biopsychosoical model, 4–5, 91b, 262 and eating disorders, 298–9 as carriers of culture, 82 historical context, 22 and madness, 274 causal role in eating disorders and weight humoral model, 21, 24–6 and personality disorders, 332–3 concerns, 290, 291 integrated model, 137–8 Rose’s model of, 88–92 discrimination against mental health limitations of, 16 limbic kindling, 210 service users, 8 pathoplastic model, 56 Lincoln asylum (England), 30 Hearing Voices Network liaison with, 154b psychogenic model, 21, 24, 27, 29–30, 37, linkage studies, 81 service users/survivors’ liaison with, 146 43 Linnaeus Medical Act of 1858 (UK), 31, 32t psychosocial model, 7, 8 Genera Morborum, 34 medical diagnoses, 104–5 sociogenic model, 21, 43 literature vs. psychiatric diagnoses, 105–6 somatogenic model, 21, 24, 26–7, 33, 34–6, representation and understanding of purposes of, 103 37 madness, 27–8 see also psychiatric diagnoses molecular genetics, 78, 81 lithium, 167 medical model of distress and eating disorders, 299 lobotomy, see prefrontal leucotomy promotion by pharmaceutical industry, search for schizophrenic gene, 263 Locke, J. 234–5, 251 Money, J., 238 notion of insanity, 27, 29–30 and psychiatric diagnoses, 102 Moniz, A. E. Lombroso, C. service users/survivors movement development of prefrontal leucotomy, 39 degenerationist theory of, 33 opposition to, 142, 279–80 monoamine oxidase inhibitors (MAOIs), 166, Lord, C., mental hospital attendant, 44 melancholy 209, 213–14 loss of personal meaning, 110–11 classical Greek descriptions of, 24, 195 monoamine imbalance lunatic(s) historical recognition of, 195–6 causal role in sadness, 208 etymology of, 20 see also sadness and worry mood stabilizers, 160 preservation of public order and, 28–9 mental disorders moral management, 29–30 Lyons, J. DSM-IV defi nition of, 13b Morel, B. concept of self-contained individual, 310 Mental Health Act, 1959 (UK), 44 Treatise on Physical and Moral Mental Health Act, 1983 (UK), 337 Degeneration, 33 MAC-UK, see Music and Change programme Mental Health Act, 2007 (UK), 142, 147–8, 159, Moser, C., 238, 239, 241 madhouses 169, 337 Mosher, L., 278 in 16th-18th century, 28 Mental Health Media, 146 Soteria approach of, 277–8 see also asylum(s) Open Up initiative of, 149 MPU, see Mental Patients Union Madhouses Act, 1774 (England), 31, 32t mental health nurses, 339–40 Mullins-Sweatt, S. N., see Widiger, T. A. & madness, 6, 250–1 mental health professionals, 339–40 Mullins-Sweatt, S. N. Battie’s types of, 29 and client power relations in multiple personality disorder, see dissociative classical Greek approach to, 24–5 psychotherapies, 177–9 identity disorder cultural constructions of, 69 integrative practitioners, 174 Music and Change (MAC-UK) programme, 181 historical construction of, 251 negative attitudes towards those diagnosed fi ctional representation of, 28 with personality disorder, 333 narrative therapies, 178–9 Foucault on conceptions of, 48 Mental Hygiene movement, 23 nasogastric feeding/force-feeding, 300–1 large-scale institutionalization of, 32–4 mental illness, 5–6 National Committee for Mental Hygiene, 23 stigma and discrimination, 255–6 public attitude about, 7–9 National Health Service (NHS) (UK), 42 see also distress; psychosis Szasz on, 48 community psychology, 181 Mad Pride (organization), 150, 151b see also distress infl uence on development of clinical major tranquilizers, see antipsychotics mentalization-based treatment, 330, 335 psychology, 45 male erectile dysfunction, 227 Mental Patients Union (MPU), 51–2 National Institute for Health and Clinical manic depression metacognition, 93 Excellence (NICE) (UK), 159, 174, 182, Kraepelin’s conception of, 35, 252 migration, 72 183b, 212 psychiatric medication for, 167 and incidences of psychosis, 72–3 on CBT effi cacy for eating disorders, 302 see also bipolar disorder mind criticisms of, 183b MAOI, see monoamine oxidase inhibitors “all in the mind?”, 15–16 guidelines on antisocial personality Marín-Baró, I., 180 bicameral mind, 152 disorder, 330 marriage and long-term relationships Eastern traditions’ views on, 69–70 guidelines on borderline personality impact on mental health problems, 65–6 Plato’s views on, 24 disorder, 329–30 Marx, K. theory of mind (ToM), 273 intervention guidelines for antisocial on asylums, 32–3 WHO’s African mind study, 62 personality disorder, 336–8 masochistic personality disorder, 109 see also psyche intervention guidelines for borderline diagnostic criteria for, 109b mind-body dualism, 15, 26–7, 69 personality disorder, 334, 335, 336 Masson, J. Mind (charity), 388, 143, 149, 252b intervention guidelines for eating disorders, Against Therapy, 37 MindFreedom International, 51, 151b 300 on therapist role, 177 mindfulness-based cognitive therapy (MBCT), recommendations for ECT, 275–6 Masters, W. & Johnson, V., 234 216 National Self Harm Network (UK), 145 sensate focus exercises, 236 Mind, Rethink and Together (charities), 144, Nazi Germany on sexual response, 225 149, 150 mass sterilization and extermination masturbation, 236 Mischel, W. programmes, 39–40 May, R., 169, 274 critique of personality theories, 310, 311–12 neurasthenia, 22–3 MBCT, see mindfulness-based cognitive models of distress, 16 in Eastern hemisphere, 66, 71, 196–7 therapy and attitudes association, 256–7 neuroleptics, see antipsychotics McRae, R. R., see Costa, Jr., P.T. & McRae, R. R. biomedical model, 7, 8, 50, 76, 136 neurologie, 26 PROOF 416 INDEX

neuroses, 5b, 37 persecutory delusion, see paranoia Powell, E., UK Minister for Health, 44, 46 forms of, 102–3 personal agency and meaning, 135–6 predictive validity of psychiatric diagnosis, 107 neurotransmitters personality disorders, 309 prefrontal leucotomy, 39, 43, 168, 275 causal role in distress, 76–8, 129–30 causality in, 323–33 presentist histories, 21b causal role in eating disorders, 298 diagnostic criteria for, 106 Present State Examination, 62 causal role in personality disorder, 331–2 history and cultural context, 309–13 prevalence rates, 257–8 causal role in sadness and worry, 209–10 psychiatric diagnosis of, 314–23 of ‘chronic neuroleptic users’, 166 eff ects of psychoactive drugs on, 161 psychiatric diagnosis of, bias in, 324–5, of distress across cultures, 62–3 imaging studies, 264 327–8 of eating disorders and weight concerns, social infl uences on development of, 94–5, stigma attached to, 110 289–90 96 personality theories, 310–12 of eating disorders and weight concerns NHS, see National Health Service Petersen, D. across cultures, 287–8 NICE, see National Institute for Health and A Mad People’s History of Madness, 22 of personality disorders, 313–14 Clinical Excellence Petit, G. S., see Dodge, K. A. & Petit, G. S. of personality disorders by gender, 327 No Force (group), 142 pharmaceutical industry of personality disorders, problems with, non-consensual sex, 224 infl uence on shaping of diagnostic 314–16 normality and abnormality, 11 classifi cation, 43–4 of sadness and worry, 200–1 cross-cultural perspectives of, 61–2, 108 pervasive role of, 251 of schizophrenia, 257–8, 265 eating problems and weight concerns, promotion of medical model of sexual of sexual problems/dysfunction, 225, 228b 285–6 problems/dysfunction, 234–5 preventative interventions, 281, 334, 336–7 in sexuality, 220–1 research funding, 82 primary prevention, 281 Nuremberg Code, 40 pharmacology, see psychopharmacology private madhouses Nuremberg ‘doctors’ trial’, 40 pharmacotherapy England, 17th century, 28 for sexual problems/dysfunction, 236–7 probabilistic causality, 121–2, 123 obesity, 284, 285 see also psychiatric medication probandwise concordance, 79, 80b occupational therapists, 340 phenomenology of experience, 17–18 prodrome, 279 Oedipus complex, 37 phentolamine, 236–7 professional cultures, 57–8 oestrogen, 231 Philadelphia Association, 48 in Zambia, 59b operant conditioning, 42, 278 phobias professionalization, 30 for eating disorders and weight concerns, causality in, 201, 202b of asylum management, 30–1 301 and classical conditioning of refl exes, 206–8 see also legitimacy of psychiatry organic diagnoses, 78 list of, 199b professional users, 148 organisms and environment, see systematic desensitization of, 216 Psichiatrica Democratica (Democratic interpenetration physical interventions Psychiatry), 49 original madness, 29 during inter-war period, 39 psyche outer speech, 93 for gender variance, 243, 245, 246–7 Freud’ s model of, 37 for madness, 274–6 Plato’s tripartite division of, 24 paedophilia, 238–9, 239b psychosurgery, 43, 168, 215 psychiatric abuse, 40–2 interventions for, 240b–1b for sadness and worry, 214–15 psychiatric diagnoses pairwise concordance, 79–80 see also psychiatric medication; consequences for service users, 109–11 panic attacks, 199, 202b psychological therapies/ diff erences between England and France, catastrophic misinterpretation in, 206 psychotherapies 63b cognitive behavioural therapy for, 216 Pick, A. diff erences between formulation and, 116t paranoia, 20 diagnosis of dementia praecox, 35 diff erences between medical diagnoses ‘healthy cultural paranoia’, 326 Pilgrim State Hospital (Brentwood, US), 44 and, 105–6 Kraepelin’s conception of, 252–3 Pinel, P., French physician, 27, 29, 30 of eating disorders and weight concerns, paranoid delusions Plato, 20 109, 289 cognitive research on, 273–4 tripartite division of soul, 24, 37 functional diagnoses, 78 paraphilias, 220, 221, 237–9 political dissidents history of, 102–3 debate on specifi c characteristics of, 239, confi nement of, 40–1 organic diagnoses, 78 241 politics of personality disorders, 314–23 and discrimination association, 241 view of biological causation of distress, 83 of personality disorders, cultural bias in, and distress association, 241 popular culture 324–5 parenting representation and understanding of of personality disorders, gender bias in, and eff ects of early relational distress on madness, 28 327–8 brain development, 95–8 representation of psychological therapies, problems of, 106–8 good enough parenting, 95 43 question of purpose of, 112–13 see also family possession and trance states, 68 responses to problems of, 111–12 Parkinson’s disease, 35 post-encephalitic Parkinsonism, 35–6 of sadness and worry, 200 pathoplastic model of distress, 56 post-natal depression, 203 of sexual problems/dysfunction, 225–7 patients, 6 postpsychiatry, 50 as social judgement, 108–9 see also service user/survivors post-traumatic stress disorder (PTSD), 47, see also Diagnostic and Statistical Pavlov, I. 207–8 Manual of the American Psychiatric on classical conditioning of refl exes, 37–8 and war experiences, 270–1 Association; formulation; penicillin, 31 poverty International Classifi cation of Perceval, J. and distress association, 132 Diseases A Narrative of the Treatment Received by a and schizophrenia diagnosis association, psychiatric medication, 159, 160–8 Gentleman during a State of Mental 266–7 for antisocial personality disorder, 337–8 Derangement, 22 and survivor predicament, 143b for borderline personality disorder, 336 PROOF INDEX 417

causal role in sexual problems/dysfunction, use of the term, 255b on prevalence of personality disorders, 230 and violence, 8–9 314–16 current classifi cation of, 165t see also distress and self-interest, 83 for eating disorders and weight concerns, psychosis risk syndrome, 112b service user/survivor involvement in, 145 304–6 psychosocial model of distress, 7, 8 responsible clinicians, 169, 340 evidence for, 162–4 of schizophrenia, 265–71 retrograde amnesia, 214 models of drug action, 160–1 psychosurgery, 43, 168, 215 Rhazes (al-Rāzi), 23b for psychosis, 275–7 psychotherapists, 339 Ribot, T.-A., 310 for sadness and worry, 212–14 PTSD, see post-traumatic stress disorder risperidone, 276, 277 types of, 164–8 public opinion Ritalin, 167 psychiatrists, 339 about causality of schizophrenia, 256 Rogers, C. R. psychiatry about distress, 7–9 client-centred therapy, 42, 136 challenges to, 1970-present, 49–53 causal beliefs and attitudes, 256–7 Romme, M. & Escher, S., 280, 281 and Cold War, 40–2 purging, 284 work on voice-hearing, 50, 70b, 152–3 professional culture of, 57–8 Rose, D., 7, 46 see also German psychiatry; Western qualitative research study on TV news coverage on mental psychiatry and psychology on causality in distress, 127 health, 8 psychoactive drugs, 161–2 Rose, S. psychoanalysis, 173 Rachman, S. lifelines model, 76, 88–92, 93 ascendancy of, 44 technique of response prevention, 42 notion of norm of reaction, 98 vs. behaviourism, 38–9 racial isolation notion of temporal plasticity, 98 birth of, 37 and psychosis development, 72 on temporal plasticity and distress, 98–100 on causality in sadness, 206 randomized controlled trials, 162 Royal College of Psychiatrists (UK), 30, 44, 83, notion of personality, 310 for drug effi cacy, 162–4 151b vs. psychodynamic psychotherapies, 173 for eating disorders and weight problems, anti-stigma campaign, 111 psychodynamic psychotherapies, 173, 177–8 305–6 on electro-convulsive therapy, 276 psychodynamic theory, 271–2 for effi cacy of psychotherapies, 175–6 Royal Psycho-Medical Association (UK), 30, 44 psychogenic model of distress, 21, 24, 27, rational emotive behaviour therapy, 43 see also Royal College of Psychiatrists 29–30, 37, 43 reason and unreason, 26–8 Rudin, E., 40 psychological therapies/psychotherapies, Reclaim Bedlam (group), 151b Rush, B. 136, 159, 173–9, 189 recovery approach, 280 tranquilizing chair, 27, 28 1900-1945, 34–6 Reid, J., physician, 33 Russel, G. for antisocial personality disorder, 337 Reil, J. C. Maudsley method of intervention for eating for borderline personality disorder, 334–5 ‘psychiaterie’, 34 disorders, 304 effi cacy and eff ectiveness of, 174–6, 217b relapse prevention feminist approaches to, 178 for child sex off enders, 240 sadness and worry, 194–5 number needed to treat (NNT) criterion, for eating disorders and weight concerns, causality in, 201–12 189 302 contemporary forms of, 198–200 post-1945, 42–4 relapse rates, 268 and eating disorders association, 289 public’s preference for, 274 and antipsychotics usage, 166, 276 historical and cultural context, 195–8 for sadness and worry, 215–16 body image distortion causal role in, 300 interventions for, 212–17 for schizophrenia, 277–8 and mood stabilizers usage, 167 prevalence and distribution of, 200–1 therapist-client power relations in, 177–9 and problematic parenting, 268 psychiatric diagnosis of, 200 types of, 37–9, 42, 173–4 relational causation of distress, 127–9 Sakel, M. psychology and clinical practice, 136 insulin coma therapy, 39 origin myths in, 38b and personality disorders, 317–18 Samelson, F. see also Western psychiatry and see also childhood abuse and trauma; on little Albert study, 38b psychology family; life events; social causation of SANE, see Schizophrenia A National Psychology in the Real World project, 184–6 distress; sexual abuse Emergency psychopathic personality disorder, 325–6 reliability Sargant, W., 40 psychopathology, 5–6 of personality order diagnosis, 318–20 Scheff , T. J., 108 see also distress of psychiatric diagnosis, 106 schema-focused cognitive therapy (SFCT), 334 psychopathy of psychosis diagnosis, 259 schizophrenia, 50 causality in, 330–1 religion among British African-Caribbean ‘successful psychopaths’, 325–6 and madness, in the middle ages, 25–6 community, 72–3 psychopharmacology, 209 and self-starvation, 286 biological causation thesis, 76–7, 99, birth of, 43–4 religious experiences 264–5 see also psychiatric medication and dissociation, 68 and clinical psychology, 253–5 psychosis, 6, 250 representation of service users/survivors, 148–9 cross-cultural diff erences in course and and adversity, 271–4 research outcome of, 64–5 alternative research approaches to, 261–2 on causality in distress, 124–7 diff erences in psychiatric diagnosis of, 63b cultural construction of, 66 on causality in distress, diffi culties, 124 dimensional vs. categorical approaches, forms of, 102–3 cross-cultural, 108 261–2 impact of marriage/long-term relationships on effi cacy of psychotherapies, 174–6 double-bind theory of, 42 on, 65 facilitation and support of Hearing Voices DSM criteria for, 105, 106, 258 interpretations in European societies, 70b Network, 154b epigenic aspects of, 92b psychosocial interventions for, 277–81 funding and pharmaceutical companies, 82 genetic predisposition to, 262–3 signifi cance of migration in development on peer support amongst service users/ impact of marriage/long-term relationships of, 72–3 survivors, 183–4 on, 65–6 PROOF 418 INDEX

schizophrenia – continued and therapists’ power relations in Shakespeare, W., 27, 28 physical interventions for, 275 psychotherapies, 177–9 Macbeth, 195 prevalence of, 257–8, 265 service user/survivor involvement shellshock, 37 psychiatric medication for, 276–7 in anti-discrimination activities and see also post-traumatic stress disorder psychodynamic perspective of, 272 campaigns, 149–50 Shingler, A., artist, 151b, 185 psychosocial causation, 265–71 in anti-discrimination and media work, Shorter, E., 37 psychotherapies for, 277–81 146 notion of biological psychiatry, 33–4 traditional conceptualization of, 35–6, in arts and creativity, 146 Shotter, J. 251–4 in consultation and monitoring, 144–5 notion of joint action, 122 traditional conceptualization of, problems and government, 150 Showalter, E. with, 259–61 problems and challenges of, 149 The Female Malady, 21b Schneiderian, 64, 253 in research, 145 sick role, 110 sluggish schizophrenia, 41 in service provision, 145–6, 280 Skinner, B. F. views on Internet, 252b in training and education, 145 operant conditioning theory, 42, 278 Schizophrenia A National Emergency (SANE), service user/survivor movements, 140 Snezhnevsky, A. 141 diversity of actions and views of, 140–1 notion of sluggish schizophrenia, 41 Schneider, K., 40 problems and challenges of, 148–9 social action therapy, 187–8 ‘fi rst rank symptoms’ of schizophrenia, 64, shared beliefs and experiences, 141–2 social capital, 182 103, 253 in UK, achievements, 146–7 social causation of distress, 122, 131–4 school refusal syndrome, 67b in UK, origin and infl uences, 51–2, 143–4 and clinical practice, 136–7 Schore, A. in US, origin and infl uences, 50–1 synergistic interaction, 123b attachment theory, 95–8 sex/sexual activities, 222–3 see also relational causation of distress; attachment theory, limitations of, 97b and consent, 224 social inequalities secondary prevention, 281 and distress, 224 social drift/social selection, 131, 266 sedatives, 43 sex therapy, 235–6 social inequalities seduction theory, 37 sexual abuse, 227b causal role in distress, 132–3 selective placement bias, 263 and diagnosis of psychosis, 270 causal role in personality disorders, 328 selective-serotonin reuptake inhibitors (SSRIs), pre-pubescent ‘seduction theory’, 37 and gender association, 133 166, 208, 212–13 and social inequality, synergistic causation and madness, 266–7 side eff ects of, 167 eff ects of, 123b and sadness and worry association, self substance-dependence and, 87–8 201–2 and culture, 59–61 sexual abuse in childhood, 227b and sexual abuse, synergistic interaction de-personalization or de-realization, 199 causal role in distress, 227b eff ects of, 123b dissociation and multiple selves, 66, 67–8 causal role in distress later in life, 129, 205 Socialist Patients’ Collective (Sozialistisches Egyptian model of, 20 causal role in eating disorders, 295 Patientenkollektiv) (SPK), 52, 53b Islamic approaches to, 23b causal role in sexual problems/dysfunction social policy see also psyche later in life, 228–9, 232 conception of distress and, 21 self-advocacy groups, 139–40 and content of hallucinations association, social reform and reformers in Netherlands, 70b 269, 270b of asylums in mid-19th century, 30 in UK, 70b and dissociation, 67, 232 social relations self-defeating personality disorder, 109, 109b, and eating disorders association, 292 and body-brain system, 92–100 327–8 formulation, 115b and distress association, 183–4 self-esteem reliability of disclosures of, 269 ‘joint action’ in, 122 and eating disorders and weight concerns, and substance-dependency problems social sciences 293 association, 87–8 downplay of biological causation of self-harm, 169–70 see also childhood abuse and trauma distress, 84–5 question of symptom or coping strategy, sexual arousal social status 329b variations in, 237–8 and serotonin levels, 209 ‘selfi sh genes’, 90–1 sexual disorders, 220 social workers, 339 Seligman, M., see Abrahamson, L., Seligman, sexual functioning, 225 Society for the Protection of Alleged Lunatics, M. & Teasdale, J. sexuality 22 sensory deprivation, 40 classifi cation of, 223b sociogenic model of distress, 21, 43 serotonin imbalance cultural context, 222 socio-therapy, 48 causal role in depression, 76–8, 209 and gender, 223 Socrates, 24, 251 service user/survivor(s), 139–40 historical considerations of, 221–2 Socratic dialogue, 174 discriminatory experiences of, 8–9 ‘normal’ and ‘abnormal’, 220–1 Solanus of Ephesus, 195 empowerment of, 146–7, 150–1, 182, see also gender somatization, 66, 70–1 186–7, 279–80 sexual orientation discrimination culturally specifi c forms and diagnoses of, experience-based experts’ perspective on and distress, 223–4 71–2 psychosis, 274 sexual problems/dysfunction, 220, 224 somatogenic model of distress, 21, 24, 26–7, fi rst person narratives of, 22–3 causality in, 227–30, 233–4 33, 34–6, 37 peer support amongst, 183–4 diagnostic problems of, 238–41 soul, see psyche perspective on personality disorder interventions for, 234–7 Soviet Union diagnosis, 316–17 prevalence of, 225, 228b political abuse of psychiatry, 41 perspective on psychiatric diagnosis, 113b problems in diagnosis of, 233 Space to Write project, 184 psychiatric diagnosis consequences for, psychiatric diagnosis of, 225–7 spell-binding, 161 109–11 sexual skills spirit possession terms used to refer, 140b development of, 236 zar, 68 PROOF INDEX 419

SPK, see Socialist Patients’ Collective and sexual problems/dysfunction, 231–2 migration and development of psychosis, (Sozialistisches Patientenkollektiv) testosterone, 231 72–3 Spring, B., see Zubin, J. & Spring, B. tetrahydrocannabinol (THC), 86–7, 88 prevalence of DSM IV personality disorders, SSRI, see selective-serotonin reuptake TFP, see transference-focused psychotherapy 316t inhibitors THC, see tetrahydrocannabinol ‘revolving door’ phenomenon, 110–11, 336 Stainton Rogers, R. & Stainton Rogers, W. therapeutic alliance, 136 service user/survivor movement, 51–2, critique of personality theory, 311 therapeutic communities 143–4, 146–7 Stangl, F., 39–40 for antisocial personality disorder, 337 Sex Off enders Treatment Programme start/stop squeeze techniques, 236 for borderline personality disorder, 336 (SOTP), 240b–1b starvation therapeutic pessimism, 333 social inequalities and distress, 133 DSM criteria for, 286b thought disorder, 268 somatization studies, 71 historical precursors of, 286–7 see also schizophrenia see also England; National Health Service see also dieting Ticehurst House (Sussex), 28, 33 United Kingdom Advocacy Network (UKAN), Steiner-Adair, C. token economy, 42, 254, 278 147 discrepancy theory, 293 tonic immobility, 96 United States St. Elizabeth’s Hospital (Washington, DC), 48 training and education advocacy of lunacy reforms in mid-19th sterilization, compulsory, 39, 275 by Hearing Voices Network, 154b century, 30 sterotactic subcaudate tractotomy, 215 for psychotherapists, 174 Americans with Disabilities Act, 1990, 51 stigma, 7–9, 110, 255–6 by service user/survivor activists, 145 asylums in 19th century, 30 stimulants, 43, 167–8 in social skills for the distressed, 216 clinical psychology approach, 254 straitjackets, 29, 30 transdiagnostic approach to eating disorders community psychology, 180 substance use and weight concerns, 289, 298, 301–3 compulsory sterilization laws, 39 causal role in sexual problems/dysfunction, transference-focused psychotherapy (TFP), decline of asylums, 44 230 334 degenerationist theory use, 33, 34b and childhood abuse/trauma association, transference theory, 37, 173 de-institutionalization, 46 87–8 transgender, 223, 243 dissociative identity disorder, 66, 67–8 and schizophrenia diagnosis association, and psychiatric diagnosis issues, 244–5 Epidemiological Catchment Area (ECA) 269–70 vs. transsexual, 243 study, 198 substitute experiments, 125–6 see also gender variance; lesbian, gay, ex-patients movement, 50–1 subvocalization, 156b, 273 bisexual, transgender, queer and incidences of somatization, 71–2 survey methods questioning increase in number of patients in 19th for studying causality in distress, 126 transvestite, 243 century, 33 survivors, see service user/survivor(s) trauma National Comorbidity Study, 204 Survivors History Group, 50 and classical conditioning, 207–8 outpatient commitment/assisted survivors poetry, 146 impact on mental health and quality of life, outpatient treatment, 169 Survivors Speak Out (advocacy group), 145 227b prevalence of DSM IV personality disorders, Sweden and theory of shattered assumptions, 208 316t compulsory sterilization, 39 see also childhood abuse and trauma purpose of psychiatric diagnosis in, 113 Sydenham, T., physician, 34 traumagenic neurodevelopmental model of service user/survivor movement, 50–1, symptoms and signs, 104 psychosis, 271 144 see also Diagnostic and Statistical treatments/therapies, see interventions social inequalities and distress, 133 Manual of the American Psychiatric tricyclic antidepressants (TCAs), 166, 167, 209, United States Public Health Service, 45 Association; International 213 user focused monitoring (UFM), 145 Classifi cation of Diseases; psychiatric Tuke, W., English businessman and diagnoses philanthropist, 29 vaginismus, 226 synergistic causation, 123b Tupes, E., see Cristal, R. & Tupes, E. validity systematic desensitization, 42, 216, 236 Twelve Step programme, 46 of psychiatric diagnosis, 107 systemic therapies, 179 twin studies of traditional conceptualization of Szasz, T., 12, 41–2, 128, 144 genes and environment, 90 schizophrenia, 259–61 on the concept of ‘mental illness’, 107–8 see also concordance (genetics) Van Os, J., 261 The Myth of Mental Illness: Foundations of study on diff erences in psychiatric a Theory of Personal Conduct, 48 UFM, see user focused monitoring diagnosis, 63b UKAN, see United Kingdom Advocacy Verwoerd, H., prime minster of South Africa, talking therapies, see psychological therapies/ Network 39 psychotherapies unconscious libidinal desires, 37 Veterans Administration (US), 42, 45 tardive dyskinesia, 162 United Kingdom Viagra, 230, 237 Tavistock Clinic (London), 37 clinical psychology profession, 254, 339 violence and crime TCA, see tricyclic antidepressants community care, 46 and distress association, 170, 255–6 Teasdale, J., see Abrahamson, L., Seligman, M. decline of asylums, 44 and distress association, media coverage & Teasdale, J. de-institutionalization process, 46 on, 8–9 temporal organization, 90 hearing voices self-advocacy group, 70b voice-hearing, 151–2 temporal plasticity, 90, 98 illegal drug classifi cation, 85 ‘fox possession’, 61–2 and distress, 98–100 Improving Access to Psychological possible coping strategies for, 156b and sadness and worry, 212 Therapies programme, 174 prevalence of, 257 and sexual problems/dysfunction, 232–3 Managing Dangerous People with Severe Romme and Escher’s work on, 50, 70b, temporal specifi city, 90 Personality Disorder, 337 152–3 and distress, 95–8 mental health legislation, 31, 32, 44, 53t, Von Economo, C., and sadness and worry, 211–12 142, 159, 169, 337 encephalitis lethargica, 35–6 PROOF 420 INDEX

Vygotsky, L. diagnosis of depression, 71 psychiatric diagnosis and social judgement on inter-relationship of language distinction between imagination and of, 109 development and thought, 93 reality, 69 psychiatric diagnosis and socio-economic emotion and cognition in, 62 status of, 132 war view of distress, 57–9 and psychiatric diagnosis association, 133 and psychotic experiences association, view of somatization, 70 sadness and worry experiences of, 203 270–1 see also German psychiatry ‘schizophrenogenic mothers’/’refrigerator Warner, R. White City project (London), 187–8 mothers’, 42 on recovery approach, 180, 280 WHO, see World Health Organization White City project, 187–8 waswas (culture-bound syndrome), 197 Widiger, T. A. & Mullins-Sweatt, S. N. see also gender Watson, J. B. dimensional approach to personality Women at the Margins, 317 Behaviorism, 38 disorders, 322 Women/Men Empowerment Learning little Albert study, 38b Wiggins, J. S., 310 Disability (WELD and MELD) groups, weight control behaviours, 284 Wilkinson, R. 186–7 see also eating disorders and weight epidemiological research on social World Health Organization (WHO), 47, 200 concerns inequalities, 132–3, 181–2 African mind study, 62 weight gain Willis, F., physician to King George III, 29 Collaborative Study on Psychological promotion of, 300–1 Willis, T. Problems in General Health Care, promotion of, using antipsychotics, 306 Cerebri Anatome (Anatomy of the Brain), 62–3 WELD and MELD groups, see Women/Men 26 studies on schizophrenia, 64–5 Empowerment Learning Disability Winwick Hospital, (Warrington, England), 33, study on social causation of distress, 133 groups 45b study on somatization, 71 Wendigo psychosis (culture-bound Wolpe, J. study on women’s health and domestic syndrome), 67b notion of systematic desensitization, 42 violence, 203 Western culture/societies, 58 women view of homosexuality, 222 attitudes towards body image and eating, anxiety disorder diagnosis, 198 worry, see sadness and worry 284, 285, 287 cultural ideal of body image, 284, 285, diff erences in psychiatric diagnosis of 291–2 York Retreat, 29, 30 schizophrenia, 63b eating disorders and control association, individualism in, 59 292–3 Zambia perspective on biological causation of experiences of sexual problems/ professional culture in, 59b distress, 76 dysfunction, 234b zar (culture-bound syndrome), 68 perspective on psychiatric diagnosis, 108 and hysteria, 37 Zeitgeist approach to history, 21b sadness and worry, 197–200 with learning disabilities, 186 Zubin, J. & Spring, B. understanding of self, 60–1 mother-daughter relationship and gender stress-vulnerability model of schizophrenia, Western psychiatry and psychology transmission, 293–4 262 PROOF PROOF