Psychology, Mental Health and Distress

First edition

by John Cromby, David Harper & Paula Reavey

End of chapter questions

Part one: Concepts

Chapter 2: History

  1. What different ways of understanding distress have there been and why is distress currently seen as an issue of health?
  2. To what extent has the dominance of particular models been a result of struggles between different institutions and professional groups?
  3. To what extent are modern debates about the relationship between biology and the social environment related to earlier debates between competing kinds of causal explanations such as somatogenesis, psychogenesis and sociogenesis?

Chapter 3: Culture

  1. If different cultures have different standards for assessing psychological distress, what does that tell us about universal measurements?
  2. Why do certain countries have better recovery rates for psychological distress (even for the so-called ‘serious’ psychotic states?), despite having less or no access to psychiatric treatments such as medication?
  3. Does how we understand the mind and body affect the way we experience and professionally treat psychological distress?
  4. Could a combination of quantitative and qualitative forms of assessment that do not rely on diagnostic categories produce a more accurate picture of rates and recovery from psychological distress?

Chapter 4: Biology

  1. What difficulties do Western cultural assumptions about relationships between mind and body create for our attempts to understand the role of biology in distress?
  2. Recent advances in genomics (gene science) and neuroscience mean that knowledge if accumulating at an ever-increasing rate. Will this new knowledge solve the conceptual problems associated with existing biological evidence?
  3. Will it ever be possible to create a valid biopsychosocial model of distress?
  4. Steven Rose’s ‘lifeline’ model offers a sophisticated way of thinking about the relationships between genes and environments, but how can it be used to guide research?
  5. Will it ever be possible to conduct experiments to prove or disprove Schore’s theories about the way that the frontal lobes develop?
  6. Can we include the effects of early childhood in analyses of distress without using troublesome categories such as found within attachment theory?
  7. How do the known problems of reliability and validity associated with psychiatric diagnostic categories impact upon our attempts to understand the associations between biology and distress?

Chapter 5: Diagnosis and formulation

  1. Psychiatric diagnosis contain an inescapable element of subjective judgement: does that mean that it is unscientific?
  2. Will it ever be possible to create a culture-free system of psychiatric diagnosis?
  3. To what extent can the stigmatizing effects of diagnoses such as schizophrenia be alleviated by changes in terminology – for example, by calling it psychosis?
  4. To what extent are the changes being proposed for DSM-5 likely to address the problems identified by critics of psychiatric diagnosis?
  5. Is the DSM just one example of a wider phenomenon of ‘medicalizing’ everyday life?
  6. What are the differences between a psychological formulation and a factual account of a person’s life and experiences?
  7. What might some clinical psychologists be unwilling to entirely dispense with diagnosis and just use formulations instead?
  8. Re-read the formulation for Sarah in this chapter. One of the main purposes of a formulation is to indicate possible interventions. What interventions might follow from this formulation? What interventions might follow from the diagnosis? What differences do you notice?

Chapter 6: Causal influences

  1. Which social psychological processes are relevant to the identification of causal influences in distress, and how?
  2. What does it mean to say that causality in distress is complex, multiple and over-determined, and how would you apply this understanding of causality to the diagnosis of schizophrenia?
  3. Evaluate the research methods typically used to explore causal influences upon distress: what are the strengths and weaknesses of each?
  4. What kinds of causal influence have been identified in relation to experiences of distress? Answer this question with respect to any one psychiatric diagnosis.
  5. Why is the possible causal influence of family and relationship factors in relation to diagnoses such as schizophrenia still seen as controversial?
  6. Why must we be wary of over-stating the importance of personal agency in relation to understandings of the causes of distress?
  7. In what ways would an integrated model of causal influences upon distress be helpful to psychologists in clinical practice

Chapter 7: Service users and survivors

  1. What is the service user/ survivor movement and what has it achieved?
  2. Why was there a need for such a movement?
  3. How is it related to other campaigns for civil rights?
  4. What are the aims of the Hearing Voices Movement?
  5. How does the approach of the Hearing Voices Movement differ from that of traditional psychiatry?

Chapter 8: Interventions

  1. What might be the implications for mental health services of adopting a ‘drug-centred’ model of drug action?
  2. Since the placebo effect is generally far more powerful than any experimental intervention, could a new class of interventions be developed that harnesses it for more effective use on its own (as opposed to it only being seen as something to be controlled for)?
  3. Since it is hard to ‘blind’ participants in traditional psychotherapeutic research trials, how might study methodologies need to be changed in order to better assess the efficacy and effectiveness of psychotherapies?
  4. What might a mental health service based on community-level interventions look like?

Part two: Forms of distress

Chapter 9: Sadness and worry

  1. How should we understand cultural and historical variation in experiences of sadness and worry: does it make sense to distinguish between culturally specific ‘illnesses’ and biologically universal ‘diseases’?
  2. What are the benefits and costs of (a) treating sadness and worry as separate experiences of distress, and (b) treating them as aspects of the same kind of distress?
  3. How might we identify the most significant causal influences upon experiences of sadness and worry?
  4. What is the evidence for the effectiveness of psychological interventions for sadness and worry?
  5. How good is the evidence that some interventions for sadness and worry are better than others?
  6. How adequate is the ‘serotonin hypothesis’ as an explanation for the experiences that lead to a diagnosis of depression?
  7. Why does gender difference seem to be so important in relation to experiences of sadness and worry?
  8. In what ways for psychological accounts of sadness and worry tend to disembody these experiences?
  9. In what ways do medical and psychiatric accounts of sadness and worry tend to individualize these experiences?
  10. What are the consequence of analysing experiences of sadness and worry separately from the experiences associated with a diagnosis of schizophrenia?

Chapter 10: Sexuality and gender

Sexual problems

  1. If the problems with sex or experiencing orgasm during sex are common, should they be viewed as mental disorders?
  2. Should we always view sexual problems in the context of the relationship in which they occur?
  3. Are problems with sex linked to levels of distress more generally?
  4. Why do women experience higher numbers of sexual problems than men?

Sexual disorders

  1. Are paraphilia-type fantasies uncommon?
  2. Does unusual sexual attraction always lead to distress?
  3. Are sexual disorders a matter of social/moral/legal, as opposed to scientific judgement?

Gender identity and transgender

  1. Should transgender individuals be viewed as disordered?
  2. Is gender variance in itself distressing?
  3. What are the practical benefits of receiving a diagnosis relating to transgender

Chapter 11: Madness

  1. Given that many psychotic experiences are more common than traditionally thought, should they be understood as variations of human experience rather than symptoms of an illness?
  2. Is it possible to research the early life experience of people who have psychotic experiences without this being seen as ‘blaming families’?
  3. Is a focus on particular experiences or complaints the best alternative to the use of global diagnostic categories like schizophrenia?
  4. Given the evidence in support of psychosocial interventions, why is medication by far the most common treatment for people with a diagnosis of schizophrenia?

Chapter 12: Distressing bodies and eating

  1. Weight concerns are common: what do they tell us about the values in our society?
  2. Why do girls and women seem to experience greater distress relating to body image?
  3. Why is self-worth linked to body image concerns for individuals with problem eating?
  4. Are diagnosed eating disorders discrete categories?
  5. Are family therapies more effective for younger people?
  6. What does cognitive-behaviour therapy appear to work for those who binge and purge?

Chapter 13: Disordered personalities?

  1. Are the kinds of problematic experiences seen as characteristic of personality disorder most helpfully viewed as disorders of personality?
  2. Given the sustained criticism this diagnostic category has received, how has it survived for so long?
  3. Is the concept of psychopathy useful in understanding the conduct of some people in the world of business and finance?
  4. How might we draw on psychological theory to develop a formulation of why mental health staff might react negatively to some of the actions associated with this diagnosis?
  5. Since there appear to be strong links between inequality and abusive experiences as a child and the kinds of problematic experiences associated with personality disorder, would it be better to reformulate these experiences as effects of abuse rather than as disorders of personality?