Psychiatry and the mental patient an uneasy relationship

Anxiety Disorders | Mental Health America

Is the expression “mental illness” merely a metaphor? . has contributed to our present conundrum over the relationship between mind. If a patient appears uneasy as they enter the office, attempt to ease the situation . List any psychiatric or medical illnesses, including method of . Record the patient's spontaneous speed in relation to open-ended questions. This article examines the complex relationship between culture, values, and ethics in . “psychologization” of mental illness—may one day become less prevalent than .. After the session, the psychiatrist began to feel uneasy about be-.

They will seek constant approval or reassurance from others. They may also isolate themselves form others, have frequent absences from school, and refuse to join in group learning or social activities.

They can become be easily frustrated and often have a fear of new activities so they have difficulty joining in or getting started. Obsessive Compulsive Disorder OCD is an anxiety disorder in which children have unwanted and repeated thoughts, feelings, ideas, sensations often called obsessions that make them feel like they have to perform little rituals compulsions in order to control their thoughts and feelings.

Rituals might include checking and rechecking their book bag or door clock, counting and re-counting or re-arranging objects or repeating the same phrase. Children with OCD may touch the same thing over and over, check and re-check things constantly or have the same thought over and over.

When this happens they may not feel in control of their actions. Sometimes compulsive activities may become so time consuming that child has little time to concentrate on other things, they may avoid friends, family or school fearing that others will recognize their odd behaviors or try to stop them.

Children with OCD may also be obsessed with perfection, have problems with concentration and even feel anxious or depressed, They may also have difficulty communicating their needs and letting people know what is going on and how they feel.

Panic disorder may be diagnosed if your child experiences at least two unexpected panic or anxiety attacks followed by at least one month of concern that they may have another one. Panic attacks are events that come on very suddenly and for no apparent reason. Can be diagnosed when a child has an unrealistic and overwhelming fear of a specific object or situation. A specific phobia is an intense, irrational fear of a specific object, such as a dog, or a situation, such as flying or being picked for a team.

Common childhood phobias include animals, storms, medical procedures, heights, water, blood, and the dark. Children will usually try to avoid situations or things that they fear; when they cannot they will feel overwhelming anxious and as a result may develop headaches or stomachaches, cry, be very clingy and may even throw a tantrum. Children usually cannot even recognize that their fear is irrational. They may often try to avoid places, people, or activities that remind them and lead them of the event Other symptoms or behaviors may include flashbacks or emotional stress from reminders of the event, difficulty concentrating, being easily startled or hyper-vigilant on-guard all the timehaving frequent nightmares and even the denial of the event itself or the inability to remember it.

Children may also seem start to act less mature, and may become whiny and clingy. Symptoms may come and go for no reason and moods change drastically and without warning, which may make it difficult, to know how to help. It is important to remember that not every child who hears about or experiences a traumatic event will develop PTSD. It is typical for children and youth to be sad and or nervous after traumatic events, but most children will recover from these feelings in a short time.

Children most at risk for developing symptoms of PTSD are those who directly witnessed a traumatic event, or who suffered directly as a result of it for example lose a family member during a fire or tornado, children and youth with existing mental health problems and kids who do not have a strong support network or people to help and comfort them.

Separation Anxiety Disorder When a child suffers from separation anxiety they experience excessive anxiety when they are away from home or their parents. They may also have extreme homesickness and refuse to go to school, camp and sleepovers and may demand that someone stay with them at night Children with separation anxiety commonly worry about bad things happening to their parents or caregivers while they are away.

It is important to remember many are toddlers it is typical for them to anxious when their parent leaves. And it is often common for them to cry when they are left with a babysitter or at day care but they usually settle down and feel better shortly after they get involved in an activity Social Anxiety Disorder: Social anxiety disorder, or social phobia, occurs when children and youth have an intense, overwhelming fear of social and performance situations and activities such as being called on in class or starting a conversation If left untreated, social anxiety disorder can make it very difficult for your child to make friends, be involved in social activities and be successful in school.

Children and youth with social phobia may be afraid to do common things in front of others and have an overwhelmingly strong fear of being judged or getting embarrassed. This fear can be so strong that it gets in the way of doing everyday things like going to school or playing a game with friends.

These same children can be very talkative and display normal behaviors in places where they feel comfortable.

Common Diagnosis

Children suffering from selective mutism may also stand motionless and expressionless, turn their heads, chew or twirl hair, avoid eye contact, or withdraw into a corner to avoid talking. For more information about anxiety disorders visit: Bipolar disorder, also known as manic-depressive illness, is a serious brain disorder that causes unusual shifts in mood, energy, and activity.

Young people with bi-polar disorder experience mood swings that can be extreme and may suffer from periods of extreme lows, or depression, and extreme highs also called mania, when the young person may feel very happy and be more active and talkative than usual. Young people experiencing mania may require little sleep, talk non-stop and show unusually impaired judgment. A young person with bi-polar disorder may also experience irritability, racing thoughts, explosive rages, delusions, hallucinations; escalated risk taking, inappropriate sexual behavior, daredevil or dangerous behavior; grandiose beliefs; and be defiant or suspicious.

Children and youth do not experience all of these symptoms and most kids have periods where their symptoms are worse than others.

Anxiety Disorders

Sometimes bi-polar disorder can be especially severe and some young people with bipolar disorder try to hurt themselves or attempt suicide. In school, students with bi-polar disorder may need extra supports as fluctuating mood and energy levels may make it difficult to learn and interact with others.

Even though bi-polar disorder is a serious brain disorder, children and youth can mange their symptoms and be successful in their home, school and community with the appropriate treatment and supports. For more information about bi-polar disorder in children and youth visit: The Balanced Mind Network at www.

Young people with conduct disorder may bully or threaten others, lie, steal, fight, destruct property, and have low self esteem masked by bravado, and show little empathy or remorse for others. Young people with conduct disorder seem to like to engage in power struggles; often react badly to demands from those in authority and may challenge household or classroom rules, refuse to do tasks or assignments and argue with others.

These behaviors can significantly impair academic success and social functioning at school, in the home and community. Whereas in general medicine the absence of symptoms often allows withdrawing the diagnosis, the psychiatric concept of remission locates an individual who has once suffered from mental illness in a more or less permanent sick role, making his or her condition chronic and subject to a long-lasting treatment.

Some of the diagnostic categories of mentall illness are based on criteria that can be seen as primarily drawing on the infraction of moral norms. A common consequence of the psychiatric diagnosis is stigma and social exclusion Gefenas ISSN Psychiatric Treatment and the "Misbehaving" Patient As a branch of modern scientific medicine, psychiatry has always occupied an uneasy position: It was only with the advance of psychotropic medications in the mid 20th century that psychiatry could finally demonstrate some more or less successful management of mental disorder.

However, together with the expected relief psychotropic medications often produce side effects that may result in new symptoms.

Dembinskas and Gokautaite-Midttunfor example, admit that poverty of emotions and speech, apathy, social withdrawal common to schizophrenia might be both a symptom of disease and a side effect of anti-psychotic medications. Efficacy of medications, however, is evaluated in terms of the frequency of relapses or hospitalizations and not in terms of the side effects see, e.

In psychiatric texts, medications are regarded as having opened new ways for understanding and treating mental illness: Patients are seen as non-adhering either because of the negative side effects of medications or because they are uncritical towards illness or fail to understand the importance of treatment see, e.

The introduction of new drug treatments in the s had a particular influence on psychiatric practice. According to Barham, psychiatrists could now style themselves as: Abnormal behavior patterns could be controlled: The psychiatrist could carry out his work as other doctors did - relieved of the burdens of attempting to follow the processes of disturbed minds, the trains and complexities of unfamiliar lifestyles, the pressures of unemployment, squalid housing conditions and poor nutrition.

There was no need to enter the jungle of human emotions - love, hatred, pain, grief It was a great deal less wearing and a great deal more respectable in strictly medical terms Barham Ingleby raises this issue: The psychiatric conception of an effective treatment raises an important observation: Insight itself is seen as consisting of three overlapping dimensions: Psychiatric conception of non-adherence provides an idea about the roles that psychiatric discourse attributes to the doctor and the patient.

The non-adhering behavior is seen as challenging professionally held behefs, expectations and norms. According to the authors, this has led to a tendency to view non-adhering patients as both deviant and culpable.

Playle and Keeley maintain that psychiatric discourse fails to take into account what the non-adherence or adherence itself means to the patient. If the patient fails to comply, the presumed lack of insight provides both the justification and opportunity for the professional to act paternalistically, diminishing the autonomy of the individual Playle and Keeley According to psychiatric conceptions of some mental illnesses like, e. According to Also, as Lowry notes, the medical model of adherence tends to look for certain features of the patient that might determine non-adherent behavior: This, according to Lowry, is problematic as it reinforces the notion of every patient as potential defaulter.

Trust in general is seen as an important aspect in psychiatric encounter. It is the patient that should trust the psychiatrist; the latter, however, should maintain some distance.

According to Dembinskas afamiliar relationships harm both the doctor and the patient. In other words, psychiatry tends to construct the picture of a mental patient as a potential defaulter, the one who should be treated with caution. If patients are more educated it can be explained to them that they have some passing mental disorder necessary to treat Dembinskas As Shergill et al.

As Gefenas notes, the Hippocratic Oath obliges the doctor to do all the best for a patient and to protect him or her from a harm and offence. This ethical principle inherent to traditional medicine is called paternalism Gefenas It can involve using coercion to achieve the good that is not recognised as such by the recipient Breeze Contemporary legal frameworks and professional codes of ethics like, e.

It is the psychiatrist, however, that decides whether there are any indications for withdrawal of such information from the patient see Article 15, Chapter 4. Hence, even if the Law grants certain rights to the mental patient, this does not mean that the patient will be able to excercise them. This suggests that paternalism in psychiatric care might be legitimated and further sustained by the very conceptualization of mental illness that in turn requires specific behavior towards the patient.

Also, the psychiatric notion of a mental illness could be seen as lacking a more optimistic scenario. This locates an individual who has once suffered from a mental illness in a more or less permanent sick role and dependency on the health professionals.

Thus, psychiatry has been largely seen as an institution of social control rather than care Bus- field According to Navarro medicine plays an important ideological role in strengthening the capitalist social order since in its emphasis on the physical causes of illness and ignorance of the social ones, it individualizes and de-politicizes the illness. It shifts the focus from the social structure to the physical realm and mutes the potential for action by the patients to change the conditions that trouble them.

It imposes its treatments more or less forcibly on those who would otherwise protest against intolerable living conditions or political repression Gerhardt Warnerfor example, has This also suggests that at least in some branches of psychiatry e. According to him, recovery rates for schizophrenia in industrialized societies are closely linked to fluctuations in economy and the requirements of the labor market. Such a focus would highlight the cultural and historical relativity of the concept and would lead to the understanding that there is nothing natural or inevitable about the modern strategies of mental illness management Foucault Empowerment of the mental patients thus is crucial for deinstitutionalized psychiatric care that aims at reinforcing capabilities of the mentally ill individuals to lead a self- dependent life in the community.

Full text of "[Coursera] The Social Context of Mental Health and Illness (University of Toronto)"

Warner also notes that economic climate may affect level of in tolerance towards mentally disordered people in the family or in the community: Paternalism is a collective form of social organization in that it exceeds the confines of a single relationship between two individuals and has a tendency to be institutionalized. Hence, paternalism in the medical encounter both reinforces and is reinforced by the powerless situation of the mental patient in the wider society. It may make the mentally ill individuals feel not entitled, not competent and also not willing to openly question their powerlessness both in the psychiatric encounters and in the wider society.

This may also explain On the other hand, in some illness situations paternalism might be indispensable and even contribute to the treatment outcomes see, e. Those who are dependent, vulnerable, dis-empowered and feeling incapable to control their illness and their lives will be more likely to accept the way they are treated and approached by the medical professionals. According to Williamsthe more powerless people consider themselves to be, the more likely that they will adjust their expectations and needs to the services that are offered to them.

Furthermore, the dis- empowering medical practices and discourses together with stigmatization, discrimination, exclusion as well as illness-related disability might make it quite difficult for mental patients to challenge their powerless situation in society. Such approach is generally characteristic of institutionalised psychiatric care settings.

In Encyclopedia of Mental Health, ed. Psichiatrijos zinios 'b-S, Approach of the Mental Patient. A Reliability and Validity Study.