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Summary 4.3 Severe Mental Illness Lectures and Notes

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  • Course
  • 4.3C Severe Mental Illness In Urban Context
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  • Erasmus Universiteit Rotterdam (EUR)

Comprehensive set of notes that covers all lectures/articles/chapters of the Slade book. These notes helped me achieve a 9.4 in the exam (and a 9.0 summa cum laude in the master overall). They are very detailed, so they are not to be treated as a quick summary, but rather as a substitute for any re...

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  • November 14, 2022
  • 158
  • 2020/2021
  • Summary

Subjects

  • severe mental illness
  • slade
  • 43

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  • Erasmus Universiteit Rotterdam (EUR)
  • Master Clinical Psychology
  • 4.3C Severe Mental Illness In Urban Context
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Exam - instructions & preparation
Dear students,
For this course, the exam is scheduled on December 11th, 1:30PM-4PM at the EUR Campus or
proctored at home. For instructions on registration, see announcement. If your opt for at-home
proctored examination, register in time!
Below, I will give some pointers on how to prepare for the exam.
This course consists of five learning paths, each build up with a video lecture, interactive lecture,
individual reading, and a tutorial group (some combining two learning paths). As was said before,
in general, everything that is discussed in the learning paths is preparatory material for the exam.
How to prepare the literature?
The pre-class reading consists of a number of selected articles, and a textbook (Slade, 2009) and
textbook chapter (Nolen-Hoeksema, 2020). For the articles, it is important that you can summarise
the core arguments and terminology. That means that you can summarize the main ideas of each
article and explain the central terminology within this argumentation. You should be able to apply
the core argumentation/terminology to examples and combine or compare these to other
articles/chapters.
For example, if your prepare the article of Westen et al (2004; week 1), you are able to name and
explain a number of assumption in ESTs that Westen et al. critique, you can explain how these
assumptions are connected to methodological choices (e.g., the role of RCTs, manualization,
selection of samples) and what the discussed alternatives would solve according to Westen et al.,
but you do not have to memorise the median effect sizes from the Smith & Glass meta-analysis or
the length of the follow-up in OCD treatment research, for example.
The textbook by Slade (2009) and textbook chapter by Nolen-Hoeksema (2020), you prepare in a
bit more detail than the articles, but it is not necessary to study on footnote-level, so to say. Again,
you have to be able to explain core arguments and critiques, you are able to list and define
models, terms and approaches and you are able to apply these to examples (in the style we did in
the Tutorial groups).
With regard to terminology: you are able to name the terms, define them (not necessarily literally
as the authors did but as close as possible) and explain in your own terms. Make sure that in
writing your answer to open questions, you always name, define and explain terms. Never let it
be up to the corrector to guess whether you understand!
Preparing lecture slides and tutorial group content
Importantly, you also prepare the slides of the lectures (both video and interactive) and are able to
explain core arguments, examples and theory. For example, I will not ask you to explain a figure
from a paper on transdiagnostic systems in detail, but I might ask you why or how a
transdiagnostic system is in fact an alternative to DSM-based diagnosis.
With regard to tutorial group meetings, you might be given a case or clinical vignette and be asked
to apply a given theory, model or critique to the example. When you answer such a question,
make sure you name, define and explain the given theory, model or critique and to explain in
concrete steps how you would apply this to the case vignette.
For example, when you would get a little part of a case vignette like Hannah's (see tutorial group
1, week 2), you are able to explain how a 'cookbook style' diagnostic system is related to the
'treatment resistance' ('uitbehandeld zijn'). In your answer, you both name, define and
explain 'cookbook style' diagnostic system, you name, define, and explain the term 'treatment
resistance', and you explain in your own terms how the two phenomena are related. However, for
example, I will not ask you to explain a term like 'GGZ shops' ('GGZ winkeltjes') which was only
mentioned in the margin of the case.

,Remember that the aim of this course is for you to get the tools to start reflecting critically on the
foundation and organisation of default psychiatry and mental health care. The aim is for you to
take these thoughts with you when you enter the 'real world' of clinical practica, so the main
purpose is for you to be able to voice core ideas and apply them to real world situations, rather
than to be quizzed on details or numbers. So you may keep that in mind while studying the
material!
Also, an important pillar of this course is peer discussion, so I can only stimulate to study the
material together, share your understanding on core arguments with each other and discuss the
consequences and possible avenues for improvement with each other.


Good luck!
Best regards,
Femke, Susan & Jessica

,Week 1: Diagnosis in context
Lecture 1: Diagnosis in context
Severe and • A major diagnosis of non-organic psychosis or a disorder that may lead to chronic
Persistent Mental disability such as personality disorder
Illness (SPMI) • Duration of at least 2 years
o Within these two years:
▪ Treatments are more intensive than outpatient hospitalization (i.e., crisis
response, inpatient hospitalization)
▪ An episode of continuous, supportive care for a period long enough to
have significantly disrupted the normal living situation
• At least two of the following disabilities (on continuing or intermittent basis) resulting in
functional limitations in major life areas
o Poor work history
o Requires public financial assistance
o Lack of personal social support system
o Needs assistance in basic living skills
o Exhibits inappropriate social behaviour which results in intervention by mental
and/or judicial system **this is the image we have when we think about SMI
(inappropriateness). Not the case for all.
“Difficult to The above definition often fleshed out
treat” patients with other factors assoc with SMI: self-
harm, safety issues, domestic
issues, personal care.

• Very often this patients called
“difficult to treat” or
“difficult”
• This can be stigmatising.
Patient gets a label; clinicians are
less likely to want to work with
these patients
• Although, it is partly factual,
because they face complex
contextual factors
o Poverty
o Low SES
o Unemployment
o Homelessness
o Criminal/ inappropriate
social behaviour
• It is not always clear who is in charge of taking care of people:
o Many institutions are involved with above issues
o Professional escalation: professionals find it hard to treat people because they
are not sure who is in charge, and how to work around the multidisciplinary care
issues
• More complexity → in addition to contextual factors, dual diagnoses are common
o Mostly substance abuse -- can be the etiology of MH problems, but also a form
of self-medication to cope with their mental health issues
o Childhood trauma, abuse and attachment problems. Makes trust hard during
MHS
o Depressive or anxiety symptoms
Perspective on
SPMI




• SMI is nothing new. Psychiatric care began with SMI

, • Assumption used to be there was no way back to a regular life
• Institutionalisation was common (and permanent)
• Critique of institutionalisation + new antipsychotic drugs changed climate in psychiatric care
= deinstitutionalization, focus on rehabilitation, focus on recovery → hope for reintegration!
From care to • From care (institutionalisation)
cure • To cure (from the medical model – the new focus in psychiatric care)
• Severe mental illness
o Terms implies medical discourse of cure
o Cure is something inserted because of drug-based treatment gave promise of
symptom-free life
• The idea of cure is a nomothetic approach: explanation of symptoms by underlying diseases.
Trying to uncover universal laws and regularities that go for everyone.
o Contrasted with idiographic which looks on the personal level – things that are
unique to everyone
o Psychological science is very much focused on law-like patterns and regularities
o → focus on universal/lawful disease states: when person X has disease Y, the
disease will cause symptoms x, y and z
o Assumption in medical model:
▪ There is an underlying cause (internal disease state)
▪ Then have a number of observable symptoms that people will have in more
or less severity
▪ If you have these symptoms in some severity/constellation, then we can
deduce the underlying disease state




• This idea is big in the medical world – look for physical disease state in the body
• But in psychology you cannot trace the underlying disease states – all we have are the
symptoms (from which we infer underlying condition)
Cure in • Ontology: state of being, theory about the world is arranged or organised; “reality”
psychiatry (1) o Disease model → underlying cause
o The ontology of cancer is something we can “touch”, a clear ontology
▪ The ontology of psychiatric diseases is harder to grasp. More vague and
complex. We work mostly with symptoms: observable signs of the
underlying cause
• Still, the idea of medial ontology is very prominent in psychology:
o Assumption: psychiatric disorders are diseases, meaning they are physical
somewhere in the body. And that this underlying disease causes symptoms
o Treatment goal becomes clear: eliminate cause
o Treatment outcome monitoring: observe reduction of symptoms as a sign that we are
eliminating the cause/ reducing the disease
o End result: no more symptoms = no more disease
Cure in • Epistemology: theory of knowledge. How can we know/understand/describe something about
psychiatry (2) reality.
o This epistemology in cure discourse has quite a big impact on how psychiatry is
organised
o → if we want to understand something about psychiatric disorders, we have to
describe symptoms as clearly as possible

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