Paper A Social Psy Notes

PAPER A
Social Psychology & Socio-cultural Psychiatry
I. Social Psychology ........................................................................... 2
II. The History of Psychiatry. ............................................................ 10
III. Basic Ethics and Philosophy of Psychiatry. ............................... 15
IV. Stigma and Mental Illness......................................................... 23
V. Culture and Mental Illness .......................................................... 24

Paper A: Social Psychology & Socio-cultural Psychiatry
I. Social Psychology
Attitudes:
Attitudes are beliefs or feelings towards objects/events. They have an affective,
cognitive and conative component (feeling, thought, and behaviour). Attitude change
may be brought about by cognitive dissonance and persuasion. Persuasion is
effective in people with an openness to change, and by strong attributes of the person
persuading change. Attitudes can be positive or negative and are closely tied to the
concepts of beliefs, biases, and judgements. Attitudes vary in terms of centrality,
consistency, and intensity and could be implicit or explicit. As attitudes have the
potential for influencing behaviour, measurement of attitudes can help understand a
person’s standing on a particular event or situation.
Measurement of attitudes: Attitudes can be measured by direct observation, direct
questioning or by using scales. The Likert scale (5 point scale assessing agreement
/disagreement), Thurstone’s equal appearing interval Scale (usually 11 intervals) and
Osgood’s Semantic Differential Scale (rating the variable according to qualities such
as curable – incurable) are used for measuring attitudes. Other examples include
Bogardus’ Social Distance Scale (attitudes towards ethnic groups), Guttman’s
Scalogram (measures degree of unidimensional attitudes).
Attribution theory
Attribution theory deals with the general principles governing how we select and use
information to arrive at causal explanations for behaviour. Initial theories were
developed by Fritz Heider (1958). People offer explanations about why things
happened; we can make one of two types of attributions: we can make an external
attribution or we can make internal attribution. An external attribution assigns
causality to an outside agent or force. An internal attribution claims that the person
was directly responsible for the event. The term ‘fundamental attribution error’ is used
to refer to the tendency to underestimate situational influences on behaviour and
assume that some personal characteristic of the individual is responsible. i.e., the
behaviour of others is normally considered dispositional, whereas the behaviour of
oneself is considered constrained or enabled by context.
For example, if your friend fails the examination it is his fault (internal attribution); if
you fail, it is because the examination was unfair (external attribution)! Attributions
can affect self-perception, people-perception and event or object perception.
Attribution needs processing of information presented from environment (who does
what) and evoking internal judgements (positive or negative) which are cognitive
functions.
Self perception was studied by Bem; person perception was extensively studied by
Heider. Kelly developed an elaborate theory for object perception. His ‘co variation
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principle’ establishes attribution with the use of three factors: consensus,

distinctiveness, and consistency.
Attributional styles, proposed by Abramson and colleagues, refer to people’s styles
of making attributions for the events in their lives. Pessimistic attributional styles
have been linked with stress and lowered immune system functioning.
Friendship and interpersonal attraction:
Increased by
• Proximity (but not invasion of personal space)
• Exposure (increased opportunity for-
• Familiarity
• Physical attractiveness
• Perceived relative competence
• Reciprocal liking
• Reciprocal self-disclosure
• Similarity of views, interests and values. Similarity outweighs
complementarity in the initial stages of a relationship but the importance of
complementarity increases with time, though it does not exceed similarity.
Self in the social context:

Obedience (to authority) is compliance with instruction. It was studied by Milgram
who reported that it is influenced by social norms, and perceived surveillance. A
surprising potency of obedience to perceived authority was revealed by Milgram’s
famous experiments. Naïve subjects were instructed by a white-coated ‘professor’ to
administer increasingly severe (fake) electric shocks to stooges when these failed on a
learning task. Obedience to the point of delivering a clearly lethal shock to a
protesting ‘learner’ was observed in 2/3 of subjects! Relative proximity to the victim
decreased compliance and an increase the perceived authority of the instructor
increased compliance (the belief that a legitimate authority gave the instruction was a
key feature). Compliance fell off dramatically when there was only one dissenting
voice present. (This study is also important as stringent ethical guidelines were
formulated as a result of the backlash from this experiment). Various situational and
social variables that influence people’s willingness to obey instructions from an
authority figure include:
§ Legitimacy: An experiment was first carried out at the prestigious Yale

University and in conditions of an experimental laboratory. When the
experiment was repeated at a run-down office building, the level of obedience
fell to 48% i.e. only 48% administered the maximum shock. `When orders
were given not by a white–coated `Professor’ but by an ‘ordinary person’ the
obedience level went down to 20%.
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§ Proximity of Learner: In the original experiment the `learnerànd the

`teacher`were in separate rooms. When the conditions of the experiment were
altered such that the `learnerànd the `teacher` were in the same room, only
40% administered shocks at the maximum level. When the `teacher `had to
take the hands of the `learnerànd put it on the switch to deliver the shock
because the subject was reluctant to administer the shock, obedience levels
went down to 30%.
§ Proximity of authority figure: If the experimenter left the room or gave
instructions over the phone, obedience was reduced to 20% including
attempts to cheat by pretending to flick switches.
§ Disagreement between authority figures: Conflict in commands given by two
authority figures brought about a dramatic reduction in obedience, with none
giving maximum shocks.
§ Defiance by peers: The variable that most reduced obedience was the
presence of an example of defiance.
§ Gender: Contrary to popular belief, females were equally likely to deliver
shocks up to the maximum level.
Conformity: This is different from compliance. It refers to the tendency for people to
agree with others in a group situation. E.g. Asch’s line judgement experiment. It the
process of yielding to pressure from others through power of persuasion or example.
Asch showed this effect in the case of perceptual judgements where subjects tended
to increase the number of false judgements of line length if several other judges
(stooges) had given false judgements previously. Conformity pressure increased
with an increase in the number of stooges. Vulnerability to group pressure is low in
individuals scoring high on measures of intelligence, social effectiveness,
expressiveness, breadth of thinking, internal locus of control and self-reliance. There
are certain conditions under which people tend to confirm to social pressure:
1. When the situation is ambiguous or the task is unfamiliar.
2. When there is unanimity within group. Groups àgreement enhances
conformity.
3. Small groups. The size of the groups appears to be important. In Asuch`s
experiments, conformity increased when the groups size increased up to four,
but further additions had little effect.
4. Group acceptance. Those who feel accepted by the group have been shown to
find it easier to deviate from the group.
Obedience refers to a change in behaviour that occurs in response to a command,

order or demand from an authority figure. In conformity the behaviour change is the
result of group’s pressure and there is no overt demand for behaviour change.
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Group polarisation is the tendency for groups to make extreme decisions than what
individuals do. People in groups tend to make decisions that are more extreme than
the positions held by individual members prior to the discussion. This phenomenon ,
known as group polarisation, refers to group discussions resulting in more extreme
decisions thatn people would ever make alone.
This has sometimes been called the risky shift because groups tended to take more
risky decisions that individual.
The polarisation effect is particularly common where group members have
not met each other before and where there is no group leader.
Groupthink: Groupthink is a concept that was identified by Irving Janis that refers to
faulty decision-making in a group. Groups experiencing groupthink do not consider
all alternatives and they desire unanimity at the expense of quality decisions.
Groupthink occurs when groups are highly cohesive and when they are under
considerable pressure (E.g. start a war against another country) to make a quality
decision. It is thus the tendency for individuals within a group to strive towards a
consensus. Leads to alternatives being inadequately explored (dissenting opinions
are suppressed), the benefits, and potential risks of preferred choice of action
inadequately explored and alternative/secondary/contingency choices of action being
inadequately explored.
Group behaviour is characterized the following features:
1. Intergroup bias: Groups show a systematic tendency to evaluate their own

groups (the in-group) and its members more favourably that the out-group
and its members. More specifically, the group –serving tendency takes the
form of favouring the in-group(in-group favouritism ) and /or derogating
the out-group(out-group derogation).
2. Out-group homogeneity effect: A key feature leading to own-group
favouritism is the tendency of groups to minimise differences between
members of the out-group and perceive them as homogeneous and
undifferentiated. The belief that the outgroup is homogeneous and similar
is an important factor in generating stereotypes and group prejudice. One
explanation for the outgroup homogeneity effect is the cognitive process of
categorisation.
3. Accentuation effect: Groups have a propensity to overestimate their
differences.
4. Intergroup competitiveness: Groups are more competitive than
individuals. Group competitiveness does have its positives effects, for
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example when teams compete to increase production or performance, but

conflict is usually not too far away.
Bystander effect: Refers to a tendency toward inaction in response to a crisis-

situation when surrounded by a crowd. It results from diffusion of responsibility
(people thinking that others may help) and inhibited behaviour in front of an
audience. Two different explanations have been put forward to explain the
reluctance of people to help another in distress:
1. Diffusion of responsibility each individual member in a group feels less
responsible to intervene when in a group that when alone;
2. Pluralistic ignorance a belief that the other bystanders interpret the situation as
harmless.
Altruism refers to helping behaviour. Along with egoism, collectivism, and

principlism, it contributes to pro-social behaviour. Altruism refers to behaviour that
is undertaken with the intention of benefiting another without the expectation of any
personal benefit. In short, it is voluntary self-sacrificing, behaviour.
Aggression: is any behaviour that is carried out with an intent to harm others (see
more details in the section on ‘observational learning’). Recent studies (e.g., Aronson,
Wilson, & Akert, 2005) have revealed that viewing violence depicted in the media, or
playing video games that have components of aggressive acts, can increase
aggressive behaviour (but an alternative argument propounds that media/ games etc.
depict variation of violence that is already present in society). Other factors that can
increase aggression include substance use (diminished judgement and control), poor
frustration tolerance, and physical discomfort (hunger, very hot weather, pain, etc.).
Presence of and access to weapons have also been associated with violent behaviour.
The drive theory is based on the frustration-aggression hypothesis (various external
sources create the drive-or motivation-for aggression, one such drive results from
frustration which can trigger aggressive acts; the ‘Yale group: Dollard, Doob, Miller,
Mowrer, & Sears, 1939). Berkowitz proposed that emotions interact with cognitions
to moderate or trigger aggression. Other explanations are biological (testosterone-
serotonin balance), and psychodynamic (the ‘death’ instinct).
Stanford prison experiments (Zimbardo, 1971) : A study of ‘captivity’ and its effects
on inmates and prison authorities. In an experimental situation ‘prison guards’ acted
more brutally than expected, while ‘prisoners’ accepted and suffered sadistic
behaviour of the guards. Situations such as conditions which facilitated movement
away from personal identity and resulting responsibility e.g., wearing dark glasses to
prevent eye contact, guards holding batons, prisoners dressed in coarse cloth etc.,
were created to encourage disorientation, depersonalisation and deindividuation.
Participants were found to ‘internalise’ their roles and act accordingly. De-
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individuation involves the loss of one`s sense of personal individuality and identity.
It also involves the merger of such identity with those of another person or group.
This study demonstrated the expression of role expectation and gave strength to the
idea that social roles compel people to act in a particular way even if it may be extreme.
This increases when legitimised by society or an institution.
Locus of Control (Rotter) refers to an individual's perception of what are the main
causes of events in life. A locus of control orientation is a “belief about whether the
outcomes of our actions are contingent on what we do (internal control orientation)
or on events outside our personal control (external control orientation)”. This concept
was developed by Julian Rotter in the 1960's
Leadership:
It is the process whereby the individual influences a group of individuals to

achieve a common goal. (Northouse, 2001) The qualities of a leader depend on
specific situations. Hence different people tend to become leaders in different
situations. For example, most groups tend to have both task-oriented and emotion-
oriented leaders, with the two roles rarely being filled by the same individual. High
productivity has been shown to be associated with relationship-oriented leadership.
Three styles of leadership based on the behavioural patterns of leader have been
described by Lewin et al:
1. Autocratic leadership refers to when the leader is aloof, dominant, takes all the
decisions and is very task centred.
2. Laissez-faire leadership style is where the leader`s input is minimal, limited to
supplying material and information.
3. Democratic leadership style involves decision by group discussion aided by the
leader.
In the original experiment, groups with autocratic and democratic leaders were
equally good at task accomplishment but members of the group with an autocratic or
laissez-faire leader were aggressive to each other and abandoned the task in the
leader’s absence. Filedler’s contingency model attempted to predict leader effectiveness
by balancing leadership style against context variables. He enumerated three
important variables that determine situational favourableness:
1. Leader-member relations- the degree to which the leader is accepted and
supported by the group members.
2. Task structure - the extent to which the task is clear and defined, with explicit
goals.
3. Leader’s position power - the extent to which the leader has the power to enforce
compliance and control group members through reward and punishment.
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According to research by Alimo, characteristics of an effective leader include

allocation of work.
Social influence and social power: Collins and Raven established 6 types of social
power:
1. Reward power - the power to provide rewards
2. Coercive power - the power to punish
3. Referent power- power through identification with the leader.
4. Expert power –power resulting from having greater knowledge or skills.
5. Legitimate power – power bestowed by virtue of social position.
6. Informational power – power arising from possession of valued information
that is unknown to others.
Persuasive communication: Persuasion is the conscious attempt to change attitudes

through communication of some message. The communication model developed by
the Yale Group (Haovland, Janis & Kelly, 1953) on the four main variables in
persuasive communication:
Communicator Message Audience Channel/Medium

Credibility Confident Delivery Personality Method of delivery
Expertise Fear appeal Intelligence Style of presentation
Attractiveness Two sided messages Self esteem Body language
Likeability Order of Presentation Anxiety
Similarity with audience Humour Mindset Repetition & Conclusions
By far the most important factor that influences attitude change in the audience is the
reliability of the person delivering the message.
Conversation: It has been proposed that conversation have a very clear structure in
terms of ‘conversational turns’. We do not normally speak at the same time and there
are clear turn-governing mechanisms, which ensure this. The most obvious is when
we ask a question or use a stereotypical sequence such as ‘hello’. We can convey our
readiness to ‘yield the floor’ by our intonation. We fill our pauses with ‘ums’ and
‘ahs’ when we wish to continue speaking. The direction of our gaze is a good
indicator of our readiness to yield the floor; if we wish to carry on speaking we
usually look away so a listener is more to interrupt if the speaker re-establishes gaze.
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Telephone conversation is mainly functional, therefore is associated with shorter

utterances than face-to-face conversations. There is also decreased spontaneity in
telephone conversations. Facial expressions are more effective at conveying emotion
than tone of voice.
Primacy effect: First impressions are powerful in forming person schema and later
ones are likely to be discarded if they are discrepant with the first. It is especially
strong if the first impression is negative.
Recency effect: Items that are presented towards the end of the list are more likely to
be remembered than those in the middle of the list.
The congruity theory holds that if one does not agree with a message from a person
he likes, he will change both the attitude towards the person and to the message.
Stereotyping: Stereotyping the is attribution to a person of a number of

characteristics or traits, which are assumed to be typical of the group to which the
individual brings. Thus, the presumed characteristics of the group are generalized
and applied to all individuals of the group.
e.g., cultural-ethnic group, occupation, geographic location, gender-based beliefs. It
refers to making inferences about a person by placing them in a category derived
from one or more quickly identified characteristics. Applies to individuals (e.g.
attractiveness) and groups (e.g. race). Has been shown to result in self-fulfilling
prophecy where an individual or members of a group live up or down to the
expectations of others. Stereotypes are not easily changed as people tend to recall
selective information that adds strength to their beliefs and dismiss contradictory
findings as stemming from ‘exceptions to the rule’. Stereotypes can be positive or
negative. It can help people process new information about people (faster, by
drawing on past experiences) and helps in adapting accordingly. Negative
stereotyping can distort and bias perception. Prejudice refers to biased judgements
made prior to reception of all facts about the person/event. Stereotypes can give rise
to prejudices and coupled with negative attitudes, it can lead to discriminatory
behaviour.
Prejudice is defined as an attitude towards members of some group, based on their

membership of that group. This may be developed to maintain high levels of self
esteem in the group, but not necessarily a person’s own self esteem.
Norms refer to expected ways of behaving in specific situations, whereas values refer
to collective beliefs about what is right, good and desirable.
Social facilitation: The presence of others improves performance on simple

responses but hinders performance on complex responses.
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However on some tasks the presence of others reduces performance. This has been
called social loafing.
Normalisation is a concept developed in learning disability services. It is described

as ‘making available to all [mentally retarded people] patterns of life and conditions
of everyday living which are as close as possible to the regular circumstances and
ways of life of society’.
Positive discrimination is a process of inclusion of marginalised groups to give a

more representative picture of the population as a whole e.g. recruiting a certain
number of individuals from ethnic minorities into the police force, even if this is at
the expense of white individuals.
Sick role as defined by Parsons’ is the role taken by people who are sick, i.e., being
exempt from normal social obligations but expected to seek and accept treatment.
Illness Behaviour as defined by Mechanic refers to the ways in which given

symptoms may be differentially perceived, evaluated and acted upon by different
individuals.
II. The History of Psychiatry.
Mental illness, or its equivalent, has been recognised for as long as there have been
records, and possibly before. Early Egyptian papyri contain references to mental
disturbances. Cases of mental disorder are recorded in the Old Testament where they
are often equated with possession by evil spirits (for example, Saul, David and
Nebuchadnezzar). Greek writings began to propose mental aberrations as disease.
Hippocrates appeared to regard mental illnesses as having bodily causes which
required treatment. Plato proposed that the behaviour of a grown man could be
affected by childhood experiences. It is important to recognise, however, that the
conceptual framework within which psychopathological descriptions have been set
has changed greatly over the years. It may not be justified to assume that terms such
as ‘mania’, ‘melancholia’ and ‘hypochondria’ mean the same now as they did even a
few hundred years ago.
Aristotle labelled emotions and suggested people were drawn to positive experiences
and avoided pain. Hippocrates classified mental illness into mania, paranoia,
melancholia and epilepsy. He also coined the term ‘hysteria’, but was referring to a
condition of women in which the womb wandered in the pelvis until cured by sexual
intercourse! The Romans were generally more punitive towards mental illness,
advocated whipping or ducking to purge the body of ghosts.
The Christian Church dominated thinking on mental illness in the Middle Ages,
producing the extremes of charity and cruelty to those afflicted. Islamic psychiatry in
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the Middle Ages used hospital treatment for the mentally ill, who were revered as
messengers from God. Art and literature from the Renaissance era suggests an
attitude of ridicule or fear towards the mentally ill in this period.
Search for a physical site for psychological and spiritual entities commenced in the
17th century. At this time, institutions for the insane such as London’s Bethlem
Hospital did exist, but conditions and treatments were unpleasant. Physicians such
as Pinel in France in the 18th century began to advocate kinder treatments and the
removal of chains. Pinel began the definition of psychological phenomenology by
describing mood swings, hallucinations and flight of ideas. The recurrent mental
disorder suffered by King George III in the 18th century aroused public interest and
led to parliamentary consideration of the care of the mentally ill through Britain. The
term “Hypnosis” was introduced by a Scottish surgeon John Braid in his lectures in
1841. Mezmer explored hypnosis further as did Charcot and Freud in the 19th
century. The preoccupation with classification was continued by Kraepelin and
Bleuler. Kraepelin developed the concept of dementia praecox (later more commonly
known by Bleuler’s term of schizophrenia) and its separation (by virtue of poor
prognosis) from manic-depressive insanity (with a better prognosis).
The First World War, and cases of ‘shell shock’ led to interest in the idea that
exposure to stress and untoward events could cause illness and nervous symptoms.
After the First World War, there was expansion of psychiatric facilities and a
broadening of their scope. In the 1920’s and 1930’s, physical treatments were
introduced such as malarial treatment for neurosyphilis, insulin coma therapy for
schizophrenia, electroconvulsive therapy and psychosurgery.
The 1950’s heralded the introduction of psychotropic medication such as lithium,
chlorpromazine, tricyclic and MAOI antidepressants. This revolutionised treatment
of psychiatric illness, with greater optimism about treating mental illness. There was
a significant reduction of psychiatric beds from 150,000 in the 1950’s to around 45,000
in the 1990’s. Though there is a misconception that this is due to the
‘psychopharmacological revolution’ in reality beds in some countries began to fall
before the introduction of medication while in others the bed numbers remained the
same despite medications. It is thought that a number of reasons led to this decrease.
Amongst them are: expansion of talking treatments in community settings and move
away from biomedical models, decreasing popularity of segregation following World
War II, cost cutting (asylums were expensive), ideas that institutionalization was not
helpful (see ‘antipsychiatry’) and pressure from mental health users critical of
hospital based treatment. Another reason for the decline in beds was a change in
social attitudes, fuelled by Erving Goffman (1961) who wrote a highly critical review
of large psychiatric institutions in the USA, terming them ‘total institutions’. He also
wrote about stigma (see below)
The origins of asylums in the 19th century as places of safe haven for people with
mental illness were rooted in social concerns of the day. Their demise and
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subsequent fall similarly reflected change in public opinion driving policy with
respect to community care. In the 21st century, recent debate suggests that we are
witnessing re-institutionalisation, with an increasing number of secure forensic beds,
an increase in compulsory admissions to hospital, and an increase in supported
housing run by private facilities.
Antipsychiatry
A group of psychiatrists went beyond the rejection of paternalism to deny altogether
the validity of psychiatric diagnoses and therefore of treatment. The term was first
coined by David Cooper, a British psychiatrist in his book “Psychiatry and anti-
psychiatry” 1967. Thomas Szasz is the foremost of the antipsychiatrists. . His central
argument is that mental illness, as a concept, has no validity.1 It is simply wrong in
his view to medicalise mental distress and abnormal behaviour with a diagnostic
label, and then to treat it – those who profess to do so are acting as unwitting agents
of social control. These antipsychiatry views were also influenced heavily by the
study of institutional psychiatric practice in America by Erving Goffman. He
described 4 main characteristics of institutions:
• Batch living (absence of boundaries between work and leisure for ‘inmates’)
• Binary management (staff controlling the ‘inmates’ while living in a different
world)
• Inmate role
• Institutional perspective
He also describes the processes as:
• Passing through the funnel of betrayal
• Civil death (as they lose all their freedoms)
• Mortification of the self (admission process, ritual stripping, examination and
acquiring institutional clothes)
Fulford has argued against the antipsychiatry movement by showing that medical
and psychiatric diagnoses are equally value-laden, and are no less scientifically
invalid.2
Important names and their contribution to psychiatry:

1. Description & Diagnosis
Name Contribution
Morel (1852) Proposed mental illnesses could be separated and classified, based

1 Szasz (1961) The myth of mental illness. Harper & Row, New York
2 Fulford (1989) Moral theory and medical practice. Cambridge University Press, Cambridge
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on aetiology. Described démence précoce

Kahlbaum Described catatonia with characteristic motor features (also
(1863) described dementia paranoides)
Ewald Hecker A mentee of Kahlbaum with whom he did research. He described
(1843 1909) hebephrenia and cyclothymia
Emil Proposed division into dementia praecox and manic-depressive
Kraepelin psychosis. Dementia praecox further divided into 3 subtypes:
(1855-1926) catatonic, hebephrenic and paranoid. Then later added 4th subtype:
simple
Defined paraphrenia separately (started middle life, free from
changes in emotion and volition seen in dementia praecox)
Eugen Bleuler Proposed the name schizophrenia to denote ‘splitting’ of psychic
(1857-1939) functions. The 4 ‘A’s: Disturbances of Associations (thought
disorder), Affective flattening, Autism (social withdrawal) &
Ambivalence (apathy). Accessory symptoms: He believed these to be
derived from loosening of associations: Hallucinations, Delusions,
Catatonia & Abnormal behaviour
Kurt Described First Rank Symptoms (FRS) pathognomic of
Schneider schizophrenia Second-rank symptoms are common symptoms
(1887-1967) of schizophrenia but also often occur in other forms of mental
illness. They include delusions of reference, paranoid and
persecutory delusions, and second-person auditory
hallucinations.
Paul-Maurice Bouffee delirante to mean a rapid onset psychosis of short
Legrain and duration. This was initially suggested by a French psychiatrist
Honore Saury Valentine Magan, but brought to completion by his two students.
(1886)
Jacob Kasanin Described schizoaffective disorder
(1933)
Mapother Coined the term derealization

(1935)
Leonard Separated schizophrenia from cycloid psychoses (non-affective
(1957) psychoses with good outcome)
Further sub-divided schizophrenia into systemic (catatonia,
hebephrenia, paraphrenia) and non-systemic (affect-laden
paraphrenia, schizophasia and periodic catatonia)
Langfeldt Differentiated schizophreniform states from true schizophrenia,
(1961) associated with better prognosis
2. Treatment:
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Name Contribution
John Cade (1949) Lithium
Paul Charpentier (1950) Synthesis of Chlorpromazine
Delay & Dineker Chlorpromazine for psychosis
Nathan Kline (1950, 1954) Reserpine, MAOIs
Roland Kuhn (1957) Imipramine
Ugo Cerletti & Lucio Bini ECT
(1938)
John Kane (1987) Efficacy of Clozapine in resistant schizophrenia
3. Psychology & related fields:

Name Contribution
Sigmund Theory of psychoanalysis, structure of personality, topography of
Freud mind, ego-defence mechanisms, concept of anxiety &
Psychoanalytical psychotherapy
Pavlov Principles of classical conditioning
Watson & Behaviourism
Skinner Skinner in particular is associated with operant conditioning
principles
Carl Rogers Client centred psychotherapy
Aaron Beck Cognitive theory of depression
John Bowlby Attachment & Bonding
Jean Piaget Cognitive Development theory
Lev Vygotsky Lev Vygotsky is generally associated with observations on play and
the ‘zone of proximal development’.
Lawrence Moral development theory
Kohlberg
Melanie Kline Objects relation theory (Paranoid schizoid position etc.)
Seligman Learned helplessness
Paul Eckman Listed 6 basic emotions which are recognized across cultures: anger,
disgust, fear, happiness, sadness and surprise
4. Famous cases
Phineas Gage (1835) 1st described case of frontal lobe injury. Following an
explosion an iron rod penetrated his frontal lobe, leading
to a change in personality without memory or
intelligence being affected.
Anna O. (1895) Treated by Bruer, her case was written up in
collaboration with Sigmund Freud and is thought to
mark the beginning of psychoanalysis
Auguste D (1906) First patient described with dementia by Aloi Alzheimer
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Little Albert (1920) Albert was chosen by John Watson and his partner
Ryaner at the age of 9 months for a classical conditioning
experiment, where they induced a fear of a rat by pairing
it with a loud noise.
5. Famous publications
Treatise on madness (1758) William Battie. A critique mostly aimed at

Bethlem Hospital.
The Interpretation of Dreams Book by Sigmund Freud, where he proposed the
(1899) topographical model of the psyche
Beyond the Pleasure Principle Essay by Sigmund Freud, describes the id, ego and
(1920) superego.
“On the Characteristic of Total by Erving Goffman
Institutions” (1957) – essay and Canadian sociologist
“Asylums” (1961) – book
“The Myth of Mental Illness” Thomas Szasz (born 1920)
(1960) and “The manufacture of American Psychiatrist and academic
madness” (1970)
“Madness and civilization” Michael Foucault (1926 – 1984)
(1964) French philosopher and social theorist
“The divided self” (1960) and R.D. Laing (1927-1989)
“Sanity, Madness and the Scottish psychiatrist
Family” (1964)
“The institution denied” (1968) Franco Basaglia (1924 – 1980)
Italian Psychiatrist and neurologist
III. Basic Ethics and Philosophy of Psychiatry.
Key Theories
There are two fundamental approaches to ethics:

1. The Duty-based approach (Deontology) – most familiar to doctors.
Originates from general obligations, codified by professional
organisations, laying down rules of professional conduct.
2. Utilitarianism (Teleology) – concerned with broad judgments of

benefit and harm. Assumes that the right action is the one that has the
best foreseeable consequence.
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1. Duty based approach:

Deontology (aka absolutism) is by far the older, taking its roots from Judeo-Christian
and Ancient Greek philosophy. The term derives from the Green deon for duty.
Immanuel Kant is considered to be the founding father of modern deontological
thinking. The main feature is rules, where rights and duties determine action. The
consequences are irrelevant. However, there is no procedure to resolve conflicts of
rights, and to determine who/what kind of things have rights, and why.
2. Utilitarianism:
Teleology (aka Utilitarianism/consequentialism) derives its name from the Greek
teleon for purpose. The general principle is that actions are determined by the
greatest good for the greatest number – i.e. it is outcome-based. These theories were
propagated by Jeremy Bentham and John Stuart Mill in the 19th century. The
consequences are all-important. However, there is no common scale for measuring
outcome, and individual interests easily get overridden for the greater good.
Different theories mainly differ in what is considered a desirable outcome, however,
the principle of ‘the greatest good for the greatest number’ persists.
3. Modern ethics:
The duty and utilitarianism approaches to ethics can conflict at times.
Tom Beauchamp and James Childress, two American philosophers, developed the
Four-Principle Approach, which is now widely used:
• Respect for autonomy of the patient – the obligation for doctors to respect
patients’ rights to make their own choices in accordance with their beliefs and
responsibilities. This requires the doctor to help patients to come to their own
decisions and then to respect and follow those decisions. This principle can
clearly be at odds with the principle of beneficence, for example when a
patient refuses treatment. Confidentiality and informed consent flow from this
principle.
• Beneficence – a fundamental commitment to doing good. When this principle
overrules that of autonomy, it is seen as resulting in paternalism.
• Non-maleficence – the avoidance of harm. A principle that is largely the
reverse side of the coin to the principle of beneficence.
Maximum benefit and minimum harm are most assured when patient
autonomy or liberty is greatest.
• Justice – the requirement for doctors to act justly and fairly (for example in the
allocation of resources).
Moral philosophy is a huge discipline and an important academic subject. It is
possible to identify two broadly competing camps within the subject – the
deontological and the teleological traditions.
16
4. Other ethics theories:

Virtue theory is different from deontology and utilitarianism as it is focused more on
the individual, and their characteristics, rather than focusing on the actions. This
theory defines virtues that people should aspire towards in order to lead a good life,
rather than defining actions. Aristotle identified moral and intellectual virtues, which
would enable one to attain the state of ‘eudaimonia’ – a state translated as
‘happiness’ or ‘human flourishing’.
Narrative ethics takes into account the actual lives of people before deciding what is
correct and incorrect for them. It does not value rules and principles and focuses on
the context for moral decision making. The aim is to make a very personal decision.
Key historical figures
In Medical ethics
Hippocrates is considered to be the father of medicine and was the first to create an
ethical code of conduct for physicians in the form of the Hippocratic Oath. This
encouraged teaching medicine, being honest, maintaining patient confidentiality and
abstaining from things that may be detrimental.
Ishaq bin Ali Rahawi was a Muslim physician who wrote ‘Adab al-Tabib’ (‘Conduct
of a Physician’) in the 9th century. It consisted of 20 chapters and included topics such
as what the physician must avoid, the dignity of the medical profession, the
examination of doctors and removing corruption in the medical profession. It is
thought to be based on ideas of Hippocrates and Galen and is considered to be the
first bo0k of medical ethics. 3
Immanuel Kant was an 18th century German philosopher who developed the
concept on ‘moral philosophy’. Kant believed that there was a single moral
obligation, derived from the concept of duty and that this moral principle should be
a principle for all people
Thomas Percival was an English physician who is considered to be the first person to
draw up a modern code of medical ethics. He published ‘The Code of Medical
Ethics’ in 1803, an expanded version of a pamphlet he had created in 1794. Percival is
also known for his interest in and campaigning for public health, especially in
relation to factory workers. 4
William David (W.D.) Ross was a Scottish philosopher at the turn of the 20th
century, who was a moral realist. He argued about the existence of moral truths.
Where consequentialist theories suggest that actions may be determined by what

3
Islam Today. Greaves R. 2010. p. 54
4
Wikipedia. http://en.wikipedia.org/wiki/Thomas_Percival
17
results in the most good, Ross argued that maximizing the good was only one of
several prima facie obligations which play a role in determining what a person ought
to do. Other obligations include: fidelity, reparation, gratitude, non-maleficence,
justice, beneficence, self-improvement.
In Psychiatry:
William Tuke opened the York Retreat in 1796 and developed a moral treatment for
insanity.
Philippe Pinel popularized methods of treatment that did not involve restraint in the
early 19th century
Key Historical events and their consequences
• Geneva Declaration (1948) – a

declaration similar to Hippocratic
oath for doctors pledging to work
Trials following the second towards humanitarian goals and
Nuremberg world war that looked at not abuse medicine
war trials physicians who conducted • Nuremberg Code (1947) – a set of
(1946-1947)5 research on a range of people research ethical principles for
inc. Jews, homosexuals and human experimentation.
the disabled and were
involved in euthanasia. • Helsinki Declaration (1964) –
Leading on from the Nuremberg
code, a set of ethical principles re:
human experimentation
A student, Prosenjit Poddar,
planned and carried out the • This trial and its rehearing
murder of Tatiana Tarasoff, a concluded that it was the
Tarasoff case girl he had befriended, but clinicians duty to protect those at
(1974-1976) who did not wish to be in a risk, even if they are not his/her
relationship with him. He had patients.
confided his plan his • Hence the psychologist should
psychologist, who did inform have broken confidentiality to
the police, but did not warn ensure safety of the victim.
Tatiana or her parents of the
possible attack.
Summary of unethical experiments conducted on humans6

5
Wikipedia. http://en.wikipedia.org/wiki/Nuremberg_Trials
18
These are all post Nuremberg code studies involving abuse and exploitation.
Description
Study
The U.S. Public Health Service conducted a research

project from 1932 to 1972 to document the natural
Tuskagee syphilis progression of syphilis. Six hundred low-income
experiment (1932 – 1972) African-American males, 399 of whom were infected
with syphilis, 201 were not infected, were recruited for
the study. Participants were given free medical
examinations, free meals, and burial insurance;
however, they were not told about their disease. The
physicians conducting the study told the participants
they were being treated for bad blood. The physicians
deliberately denied these men treatment for syphilis
and also attempted to prevent treatment from other
sources. This led to the Office for human research
protection being set up in the US along with federal
laws that would protect human subjects
A CIA experiment where whooping cough bacteria

Tampa Bay (1955) were released from boats in Tampa Bay leading to a
whooping cough epidemic.
Willowbrook State School, situated in New York State,

Willowbrook State School was an institution for children with learning disabilities.
Hepatitis studies (1963-66) Parents of children in the institution gave consent for
their children to participate in a study. The intent of the
research study was to follow the course of viral
hepatitis and study the effectiveness of an agent for
inoculating against hepatitis. Parents were provided
with study information describing the drug
administration as vaccinations. However, the children
were deliberately infected with the hepatitis virus.
There is evidence that the school only admitted children
to the school whose parents gave permission for them
to be in the study.
Tearoom Trade Study For his PhD dissertation, Laud Humphries, a

(mid 1960s) sociologist, was interested in learning what motivates
men who have anonymous sex in public washrooms.

6
Wikipedia. http://en.wikipedia.org/wiki/Unethical_human_experimentation_in_the_United_States
19
He was interested in determining their personal

characteristics and also the nature of the sexual activity.
There were two parts to the study. In the first part, he
befriended the men by acting as a lookout. Since the
public washroom was in a park the researcher was able
to take down some of the mens licence plate numbers.
He then obtained identifying information on these men
by tracing their car license plates via a policeman. A
year later, in the second part of the study, the researcher
utilized the identifying information he obtained to
contact and subsequently, interview the men in their
homes. To avoid being recognized, he altered his
appearance and claimed he was conducting a study on
health issues. The concerns with this study were the use
of deception upon deception and the lack of
opportunity for participants to provide informed
consent.
Milgram Obedience Study Stanley Milgram, a social psychology researcher at Yale

(early 1960s) University, wondered why defendants in the
Nuremberg Trials justified their unethical actions by
saying they were just following orders. Even though his
studies were designed to learn about conditions of
obedience and disobedience, Milgram used deception to
recruit participants by calling his projects learning and
memory studies. Nave participants believed they were
applying punishment, escalating electric shock, to a
learner, in response to incorrect answers to word-pair
matching questions. Actually, the learner was a
confederate (i.e., was working for the researcher) and
was not being shocked. The deception was revealed at
the end of the study.
3. Jewish Chronic Disease Hospital (1963): Studies were

Jewish Chronic Disease conducted at the Jewish Chronic Disease Hospital in
Hospital Case (1963) New York City to develop information on the nature of
the human transplant rejection process. Chronically ill
patients who did not have cancer were injected with
live human cancer cells. The physicians did not inform
the patients as to what they were doing. The physicians
rationalization for their actions was as follows: (i) they
did not want to scare the patients and (ii) they thought
the cells would be rejected.
20
Abuses of Psychiatry
Paternalism was the key ethical principle underpinning the establishment of the
county asylums in the mid-19th century in Britain. There was little legislation to
govern the workings of asylums and their forerunner, the ‘mad-houses’. There were
many publicised examples of abusive practices, especially involving the use of
mechanical restraint and seclusion. 7
The activities of some German psychiatrists during the Second World War show how
easily a benevolent paternalistic model may turn malevolent. Psychiatrists were at
the forefront of the Nazi euthanasia campaign – those patients deemed
Lebensunwertes leben (lives unworthy of life) were taken aside and murdered.8 From
the 1950’s to the 1980’s the Soviet Union systematically abused psychiatry for
political ends.9 A new diagnosis, sluggish schizophrenia, was defined so as to
medicalize politically unacceptable dissident or reformist behaviour, and detain such
individuals in psychiatric hospitals and medicate them against their will.
Common ethical issues
Negligence
The most common reason for doctors to be taken to Court is because they are being
sued for negligence. This requires the plaintiff to prove:
• That the doctor owed a duty of care to the patient
• That the doctor was in breach of the appropriate standard of care imposed by
the law
• That the breach in duty of care caused the patient harm, meriting
compensation
Doctor/patient relationship
Doctors have obligations to respect the patients’ wishes and best interests.
Unfortunately, psychiatrists have occasionally taken personal advantage of their
patients in various ways: to satisfy their own psychological needs, imposing their
own values and beliefs on their patients, financial exploitation, sexual exploitation,
putting the interests of third parties who provide or fund medical care above those of
the patient.

7
Barham (1992) Closing the asylum: the mental patient in modern society. England Books, London
8 Lifton (1986) The Nazi doctors: medical killing and the psychology of genocide. Basic Books, New
York
9 Block, Reddaway (1977) Russia’s political hospitals : the abuse of psychiatry in the Soviet Union.
Gollancz, London
21
Confidentiality
Confidentiality is fundamental in medical practice. In most circumstances, the
psychiatrist should not disclose confidential patient information without the patient’s
consent. Doctors may be obliged to disclose information to a third party in the public
interest for example, there are statutory obligations in relation to:
• communicable disease
• certain controlled drugs
• unfitness to drive, where the patient continues to drive despite adequate
advice
• suspicion of child abuse, or abuse/neglect of an incompetent patient
• by order of a Court
• where disclosure may assist in prevention, detection or prosecution of a
serious crime.
• Where deemed appropriate during an investigation into a colleagues fitness
to practice. However, in these cases patient consent should be sought and if
refused further consideration is required to appreciate whether disclosure
would be in the public interest.
If disclosure of the information is not in the public interest you do NOT have to
routinely disclose information to:
• Solicitors
• Police officers
After the patient’s death your obligation to maintain patient confidentiality persists.
Attempts should be made to anonymise/code information if at all possible (e.g. for
audit). You are obliged to disclose information about patients who have died:
• For a coroner’s report
• For national and local confidential enquiries and audits
• For public health surveillance (but most cases would be anonymised)
• To parents who are seeking to understand the cause of a child’s death
• For partners/close relatives of an adult, wishing to understand the cause of
death, if you believe the patient would not have objected
• When the person enquiring has the right to access records under the Access to
Health Records Act 1990
Consent to medical treatment

This is a procedure which underlines the importance of explaining to
the patient nature of his illness, the treatment options available and
22
making him take part in deciding about his treatment. It has three
components: access to information, competence to decide and freedom
to choose
The Mental Capacity Act 2005 essentially places into statute the key outcomes from
case law, and has five key principles:
§ A presumption of capacity,
§ The right for individuals to be supported to make their own decisions,
§ The right for individuals to make what might be seen as eccentric or
unwise decisions,
§ The obligation to act in the best interests of patients without capacity,
§ The obligation to use the least restrictive intervention.
In order to seek consent, the professional doing so must be:

• Suitably qualified to do so
• Has sufficient knowledge of the proposed investigations/treatment and the
risks
• Understands the guidance provided by the GMC and will act in keeping with
it.
Consent may be given orally (i.e. verbally agreeing to procedure), may be implied
(i.e. by complying with procedure) or may be written (i.e. consent form signed). In
some cases e.g. fertility treatment, written consent is required by law. Written
consent should also be sought if:
• If treatment/investigation is complex and involved significant risks
• There may be significant consequences for the patient’s work or social life
• Clinical care is not the primary purpose of the proposed procedure
• It is part of a research programme or is innovative.
IV. Stigma and Mental Illness
Stigma can be defined as constituting four elements:

• Labelling. In which the characteristic that are considered to be indicative of
an important difference are named.
• Stereotyping. The linking of the differences to undesirable characteristics
• Separating. Clear distinction between a ‘normal’ group and a ‘labelled’
person/group as being different.
• Status loss and discrimination. The devaluation, rejection and avoidance of
the stigmatised person/group by others
23
Rejection may be experienced in a range of areas such as employment and housing,

through to everyday minor insults. Stigma has been found to be highly prevalent
among people with a serious mental health problem living in the community.10 The
effects of labelling are mediated by social psychological mechanisms in which both
former psychiatric patients and members of the general population internalise
negative cultural conceptions and attitudes about people who have been diagnosed
with a mental illness, leading to personal discrimination. For many former
psychiatric patients a negative self-concept emerges from a combination of their
primary disability and from the cumulative reaction of others. Social rejection is an
on going and recursive experience in the community setting and a persistent form of
social stress for discharged patients.
Erving Goffman (1963) identified three forms of social stigma:
1. Experience of mental illness (or being labelled mentally ill)
2. Physical illness/deformity
3. Belonging to a particular group (race, religion etc)
Patrick Corrigan and Amy Watson (2002)11 wrote that Western countries have more
stigma regarding mental illness, than Asian and African counties. They identified 2
types of stigma: Public Stigma in which the public have misconceptions about
mental illness and thus stigmatise sufferers. The impact of this may take 4 forms:
withholding help, avoidance, coercive treatment, and segregated institutions. They
also identified 3 ways of dealing with public stigma:
1. Protest
2. Education
3. Contact
The other type of stigma identified is Self-stigma. This is a process by which
sufferers internalize the stigmatizing ideas of the public, which leads them to believe
that they are less valued, leading to low self esteem.
V. Culture and Mental Illness
Culture refers to systems of knowledge, concepts, rules, and practices

that are learned and transmitted across generations. The culture of a
particular population is the sum of work and thought expressed or produced by
members of that population, including their social practices, beliefs, institutions, and
arts.12 Although it is a reflection of people and the ecological and socioeconomic

10
Link et al (1997) Journal of Health and Social Behaviour 28: 177-190
11 Understanding the impact of stigma on people with mental illness. Corrigan P, Watson A. World
Psych. 2002. Feb 1(1). 16-20. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1489832/
12 Lopez & Guarnaccia (2000) Annual Review of Psychology 5: 571-598
24
contexts in which they live, at the same time culture exerts a profound influence on
individual behaviour, cognition and emotion.13
Culture can play an important role in the development and expression of mental
disorder through pathogenic or pathoplastic mechanisms. While some mental
disorders have a strong pan-cultural core (high degree of syndromal stability across
cultures), others are specific or unique to a particular culture (culture-bound
syndromes).
Examples of culture-bound syndromes:
• Amok. Occurs in Malays and consists of a period of withdrawal, followed by
a sudden outburst of homicidal aggression in which the sufferer will attack
anyone within reach. The attack typically lasts for several hours until the
sufferer is overwhelmed or killed. If alive, the person typically passes into a
deep sleep or stupor for several days, followed by amnesia for the event. It
almost always occurs in men.
• Koro. Also known as Suo Yang in China. Common in South-east Asia and
China. Involves the belief of genital retraction with disappearance into the
abdomen, accompanied by intense anxiety and the fear of impending death.
• Dhat. Commonly recognised in Indian culture. Includes vague somatic
symptoms and sometimes, sexual dysfunction which the subject attributes to
the passing of semen in urine as a consequence of excessive indulgence in
masturbation or intercourse. In China there is a similar culture bound
syndrome known as Shen-k’uei.
• Wendigo. Described in North American Indians, and ascribed to depression,
schizophrenia, hysteria or anxiety. It is a disorder in which the subject believes
he or she has undergone a transformation and become a monster who
practises cannibalism.
• Latah. Usually begins after a frightening experience in Malay women. It is
characterised by a response to minimal stimuli with exaggerated startles,
coprolalia, echolalia, echopraxia and automatic obedience.
Brain fag syndrome. Widespread low-grade stress syndrome described in many
parts of Africa, commonly encountered among students. Common
symptom include difficulties in concentrating, remembering, and
thinking. Students often state that their brains are fatigued.
Somatic symptoms are usually centered around the head and neck
and include pain, pressure or tightness, blurring of vision, heat, or
burning.
•

13
Fiske (1995) The cultural dimensions of psychological research. Erlbaum, Hillsdale p271-294
25
• Pibloktoq or Arctic hysteria is a culture bound syndrome appearing

exclusively in Eskimos (Inuit) living within the Arctic Circle. It is more
common in woman and tends to occur in winters. It is characterised by
hysterical behaviours (screaming or uncontrolled behaviours), insensitivity to
extreme cold, echolalia, depression and coprophagia. Often there is amnesia
for the episode. It has been explained by a variety of theories: ecological,
nutritional, biological-physiological, psychological-psychoanalytic, social
structural and cultural, and possible implication of vitamin intoxication,
namely, hypervitaminosis A.
Susto: This is condition seen in some Latinos in the United States and among
people in Mexico, Central America, and South America. Susto is
an illness attributed to a frightening event that causes the soul to
leave the body and results in unhappiness and sickness.
Typical symptoms include : • appetite disturbances, • inadequate or
excessive sleep, • troubled sleep or dreams, • a feeling of sadness,
• lack of motivation to do anything, and • feelings of low self-
worth or dirtiness. • Somatic symptoms
• Hwabyung: is a Korean word meaning “firesickness” it is based on the
Chinese concept of five elements. It is used to describe distress with
accompanying somatic and emotional symptoms.
Ataques de nervios: Literally means “attack of the nerves”. It refers to a stress
induced emotional reaction with mixed anxiety and hysterical features. The
association of most ataques with a precipitating event and the
frequent absence of apprehension distinguish them from panic
disorder.
•
• Tajin kyofusho: Is a Japanese culture-bound syndrome which takes the form
of social anxiety with sufferers worrying about offending or harming people.
Bouffee deliriante: seen in West Africa and Haiti. Sudden outbursts of
aggressive behaviour, agitation, confusion and psychomotor excitement. May
resemble an episode of brief psychotic disorder.
Zar is a generic term referring to the experience of spritual possession, which may
inlcude dissociative episodes that include laughing, hitting, singing or
weeping. Apathy and withdrawal may also be seen. Such symptoms may be
seen across east Africa and the Middle East.
Mental illness among ethnic minorities

Schizophrenia
26
The higher than expected rates of schizophrenia among Afro-Caribbean people born
in Britain have been noted since the 1960’s. Studies of hospital admissions have
demonstrated high rates of schizophrenia in this group compared to British whites
and Asians. These results have caused controversy, with criticisms of misdiagnosis
due to unfamiliar culturally determined patterns of behaviour, acute psychotic
reactions being mistaken for schizophrenia, or racism accounting for the observed
differences. There is no evidence of increased rates of schizophrenia in the West
Indies, and therefore no evidence that Afro-Caribbeans carry a greater genetic
loading for schizophrenia.
Suicide
Suicide rates are high among young Indian women at ages 15-24 and 25-34, but low
among Indian men. Suicide rates are low in Caribbeans but high in young adult East
Africans. Immigrant groups have a higher rate of suicide by burning, with a nine-
fold excess among Indian women.14
World-wide differences in mental illness
Schizophrenia: Patients with this diagnosis in developing countries have a better

outcome than those in developed countries
Bipolar disorder: Psychotic experiences of mania are more common among Nigerian
and Afro-Caribbean patients, than in European ones.
Eating disorders: Are infrequent in developing countries, despite rise in incidence in

developed countries
Neuroses: There is an increased prevalence of conversion disorder in developing

countries.
References:
Atkinson, R.L., Atkinson R. C., Smith, E.E., Bem, D.J., Nolen-Hoeksema, S. (1999)
Hilgard’s introduction to psychology (13th Ed.) Harcount College Publishers.
Gross, R. D (2005) Psychology: The science of mind and behaviour (5th Ed) Hodder &
Stoughton.
Thambirajah, M. S. (2005). Psychological Basis of Psychiatry. Elsevier Churchill

Livingstone, Edinburgh.
Companion to Psychiatric Studies, 8th edition, 2010. eds Johnstone, Cunningham

Owens, Lawrie, McIntosh, Sharpe.

14 Raleigh & Balarajan (1992) British Journal of Psychiatry 161: 365-368
27
Shorter Oxford Textbook of Psychiatry, eds Gelder, Harrison, Cowen, 5th Edition
The Encyclopaedia of schizophrenia and other disorder. Noll R. 2007.
Textbook of Psychiatry, 2nd edition, eds Puri, Laking, Treasaden
Medical Ethics and Law. 2nd ed. Baxter C, Brennan M G, Coldicott Y, Möller M. 2005.
Confidentiality. Guidance for Doctors. GMC. 2009. http://www.gmc-

uk.org/Confidentiality_0510.pdf_32611802.pdf
Consent. Patients and doctors making decisions together. Guidance for doctors.
GMC. 2008. http://www.gmc-uk.org/Consent_0510.pdf_32611803.pdf
28

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PAPER A

Social Psychology & Socio-cultural Psychiatry

I. Social Psychology ........................................................................... 2

II. The History of Psychiatry. ............................................................ 10

III. Basic Ethics and Philosophy of Psychiatry. ............................... 15

IV. Stigma and Mental Illness......................................................... 23

V. Culture and Mental Illness .......................................................... 24

principle’ establishes attribution with the use of three factors: consensus,

Self in the social context:

§ Legitimacy: An experiment was first carried out at the prestigious Yale

§ Proximity of Learner: In the original experiment the `learner`and the

Obedience refers to a change in behaviour that occurs in response to a command,

Group behaviour is characterized the following features:

1. Intergroup bias: Groups show a systematic tendency to evaluate their own

example when teams compete to increase production or performance, but

Bystander effect: Refers to a tendency toward inaction in response to a crisis-

Altruism refers to helping behaviour. Along with egoism, collectivism, and

It is the process whereby the individual influences a group of individuals to

According to research by Alimo, characteristics of an effective leader include

Persuasive communication: Persuasion is the conscious attempt to change attitudes

Communicator Message Audience Channel/Medium

Expertise Fear appeal Intelligence Style of presentation

Attractiveness Two sided messages Self esteem Body language

Likeability Order of Presentation Anxiety

Similarity with audience Humour Mindset Repetition & Conclusions

Telephone conversation is mainly functional, therefore is associated with shorter

Stereotyping: Stereotyping the is attribution to a person of a number of

Prejudice is defined as an attitude towards members of some group, based on their

Social facilitation: The presence of others improves performance on simple

Normalisation is a concept developed in learning disability services. It is described

Positive discrimination is a process of inclusion of marginalised groups to give a

Illness Behaviour as defined by Mechanic refers to the ways in which given

II. The History of Psychiatry.

Important names and their contribution to psychiatry:

on aetiology. Described démence précoce

Mapother Coined the term derealization

3. Psychology & related fields:

Treatise on madness (1758) William Battie. A critique mostly aimed at

III. Basic Ethics and Philosophy of Psychiatry.

There are two fundamental approaches to ethics:

2. Utilitarianism (Teleology) – concerned with broad judgments of

1. Duty based approach:

4. Other ethics theories:

Key Historical events and their consequences

• Geneva Declaration (1948) – a

Summary of unethical experiments conducted on humans6

The U.S. Public Health Service conducted a research

A CIA experiment where whooping cough bacteria

Willowbrook State School, situated in New York State,

Tearoom Trade Study For his PhD dissertation, Laud Humphries, a

He was interested in determining their personal

Milgram Obedience Study Stanley Milgram, a social psychology researcher at Yale

3. Jewish Chronic Disease Hospital (1963): Studies were

Common ethical issues

Consent to medical treatment

In order to seek consent, the professional doing so must be:

IV. Stigma and Mental Illness

Stigma can be defined as constituting four elements:

Rejection may be experienced in a range of areas such as employment and housing,

V. Culture and Mental Illness

Culture refers to systems of knowledge, concepts, rules, and practices

• Pibloktoq or Arctic hysteria is a culture bound syndrome appearing