Is the Historical Context of Mental Illness, really historical?

The current Medical Model of Mental illness takes the view that our mental health can be categorised, diagnosed and treated in the same way as physical illnesses.  This approach is not without its critics who take the view that the medicalisation of human experience is more of a feature of societal control for the political and economic classes to be able to manipulate behaviour to their own whims.

The medical model takes the view that there are natural albeit dysfunctional explanations to mental illness. Historical views have been more supernatural in their attributions to abnormal behaviour.  These have included;

The view, however, that these views are  a thing of the past could be considered to be an ethnocentric one.  Consider the question, is the medical model sociologically still in the minority? With the DSM (US), ICD (WHO) and CCMD (China) as the major classifications systems accounting for coverage of the US, China and the rest of the world there is technically full coverage from the ‘Top down’.  What about the bottom up?  To what extent are personal beliefs resistant to a more enlightened medical approach to mental illness?

Below is a case that recently has been brought to light in Nicaragua of how one woman’s  behaviour was demonised rather than medicalised.  The sad case highlights the role of  how a mixture of poverty, strong religious beliefs, the role of the supernatural, how women are ‘controlled’ as well as the lack of education can be a recipe for the most extremes of response.   Reader discretion advised.



A new era of the Gene Jeanie…..

Has the Nature Vs Nurture debate finally been settled in regards to Schizophrenia?   In 2016 mainstream national newspapers ran the story;

‘Schizophrenia breakthrough as genetic study reveals link to brain changes’

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The  original journal article (Sekar, 2016) the headline relates to proposed that ‘synaptic pruning’ occurs at pivotal points in development, however, excessive pruning during adolescence are matched to the symptoms experienced by Schizophrenics.  The regulation of an individual’s synaptic pruning  is specifically related to the gene ‘complement component 4‘ referred commonly to as ‘C4’.

It has long believed that Schizophrenia had an innate component, however, the  difficulty in systematically testing the impact of the environment meant clear conclusions have always been difficult to draw.  The  Diathesis-Stress Theory suggest that Schizophrenia could be caused by a biological vulnerability (diathesis) triggered by environmental factors (stress).


Gottesman and Shields (1972) classic study  attempted to pull research in the area together, by analysing a range of adoption and  twin studies including dizygotic (non-identical) and the rarer monozygotic (identical) twins, which only occur 3 in every 1000 live deliveries worldwide.  All adoption studies found an increased incidence of schizophrenia in adopted children with a schizophrenic biological parent. Kety (who was also known for his critique of Rosenhan’s study) found that biological siblings of children with schizophrenia showed a much higher percentage of schizophrenia. All twin studies found a higher concordance rate for schizophrenia in monozygotic (MZ) than dizygotic (DZ) twins.  In Gottesman and Shield’s own study the rate was 58% for identical twins, and 12% for non-identical twins.  The research was strongly suggestive of the genetic influence even back then, however, only took a reductionist biological view, largely ignoring the diathesis-stress model even though the results seem to support it. 

Is the genie finally out of the bottle?

The current Sekar 2016 research is an exciting development in answering the questions of the biological cause of schizophrenia as well as how an effective treatment may be developed. Watch this space….

Further reading

An article discussing a wide range of twin and adoption studies investigating Schizophrenia. 



The curious case of Phineas Gage……

For a short time Phineas may have been unconscious. His gang carried him to a nearby ox-cart where, sitting against its head board, he was driven to the Cavendish inn where he lived. He alighted unaided. Then from a chair on the ‘piazza’ he told his story to the bystanders. He greeted Edward Higginson Williams, the first medical practitioner to arrive, with ‘Doctor, here is business enough for you’.

Malcolm Macmillan – Phineas Gage; Unravelling the myth

phineas_gage_35quot_buttonA 25 year old Phineas Gage is a name synonymous with biological explanations to criminal behaviour. Reportedly a mild mannered individual who after having a significant brain injury from a tampering iron transformed him in terms of his behaviour and personality, giving rise to a new way of thinking regarding the relationship between brain and behaviour.

Pertinaciously obstinate, capricious, and vacillating’ about his plans for the future – ‘no sooner arranged than they are abandoned’

Harlow 1848

But how accurate are the stories of this seemingly Jekyll and Hyde case….?  An article published be the British Psychological Society via  Malcolm Macmillan is Professorial Fellow in the Department of Psychology at the University of Melbourne is attempting to put the record straight.  Click on the picture to read about this fascinating case.

Find out here what the textbooks don’t tell you about Phineas Gage!


The Clinical Psychology of Children and Young People

Edinburgh University are currently advertising some free online courses such as ‘The Clinical Psychology of Children and Young People‘.  Even though it doesn’t contribute to a formal qualification they are providing a verified statement of accomplishment (for a fee of around £32), the course run over for 6 hours per week and take from 1-3 hours.  Here are some of the outcomes they are offering;cours

  • Understand essential developmental processes and how they relate to child and adolescent mental health and well being
  • Understand key mental health difficulties that affect children and young people
  • Develop a critical reflection on the nature and perception of typical and atypical development and psychological difficulties
  • Understand and to critically examine the cultural and societal context for child and adolescent development and developmental psychopathology.

The University is also providing a range of other online programmes such as Mental Health: A global policy help develop a broader understanding of mental health and illness from a global perspective.  The Philosophy of Science is also being offered.

There are also a range on general and non-psychological courses running such as fundamentals of music and theory and the rather bespoke ‘Chicken behaviour and welfare‘.

For a full list click here.

The Rise of Cognitive Psychology -From Chunking to Cognitive Behaviour Therapy

The reason I’m not a neurobiologist but a cognitive psychologist is that I think looking at brain tissue is often the wrong level of analysis. You have to look at a higher level of organisation.

                                                                                                                     Steven Pinker-Harvard University

The Cognitive approach was initially contrasted with Behaviourism, especially in the US where the highly experimental, yet limited perspective was seemingly running out of steam, where Behaviourism was only interested in the external, observable and measurable phenomena Cognitive Psychology wanted the same experimental approach but took the view that the internal thought processes often compared with a ‘computer‘, was an area of study worth pursuing.

What are the processes within the mind shaping thought?  What were their limitations and are they fixed?  Were they applicable to all, was there a ‘human’ base model that all shared that culture and experience then could mould?  One such example, many will be familiar with terminology like short-term and long-term memory as an example of our early Cognitive Psychology devised simplistic models to represent how complex processes of memory interact. George Miller’s 7(+-2) to represent the ‘capacity’ of Short Term Memory that then produced ‘chunking‘ to seemingly generate a hack to get around the limitations of our own systems.

 For such hard wired or ‘hard-coded‘ (to maintain the often cited computer analogy), these ‘rules of thought’ were systematically studied to provide support for cognitive psychology which became the new face of experimental psychology generating memory tasks to provide evidence of our how these cognitive systems worked.  However, many studies produced basic lists of words and objects to produce effects whilst interesting were deemed to have little ecological validity.

Ecological Validity of early Cognitive based tests

The classic 1935 Stroop Test illustrates both the seeming limitations of our cognitive processes through a task that has very little generalisability to real word tasks. Take an interactive test here.

However, no ‘process’ was left unturned perception, problem-solving, attention, language and memory historically the key areas of Cognitive Psychology.  Whilst conducting highly controlled experimental work to build a body of evidence using a Nomothetic approach, some took an interest in the variations in people’s thinking whilst others took a more idiographic approach interested in the case studies of individuals whose thought processes were seemingly ‘faulty’ or ‘erroneous’. Consider how visual illusions work.  They take advantage on how our perceptual sets are fixed which means anything we are presented with that sits outside of that our mind has to either attempt to adjust or it produces an image that we cannot understand.

The faces of A and B are the same shade.  Place your finger horizontally where they meet to prove it!
The faces of A and B are the same shade. Place your finger horizontally where they meet to prove it!

The Case of HM

 One such case was that of Henry Molaiso (referred to as HM).  Aged 27 needing brain surgery HM had both parts to his  ‘hippocampus‘ removed when receiving surgery to assist his epilepsy.  What wasn’t known then is the Hippocampus structure is now thought to be crucial in the development of new memories.

However, for reasons still not completely understood (often thought to be the result of the heavy medication for the epilepsy) HM had no memory of events for the 11 years prior to the operation and unable to make new ones.  This is referred to a global amnesia constituting a completed lack of memory both prior (retrograde amnesia) and after (anterograde amnesia).  HM therefore, became a man whose memory finished when he was 16 years old without any way to process new memories.  A similar case is that of Clive Wearing watch the video below for an insight into a life where memory doesn’t exist.

Critical Evaluation

B.F. Skinner criticises the cognitive approach as he believes that only external stimulus – response behavior should be studied as this can be scientifically measured.  Therefore, mediation processes (between stimulus and response) do not exist as they cannot be seen and measured. Skinner continues to find problems with cognitive research methods, namely introspection (as used by Wilhelm Wundt) due to its subjective and unscientific nature.

Humanistic psychologist Carl Rogers believes that the use of laboratory experiments by cognitive psychology have low ecological validity and create an artificial environment due to the control over variables. Rogers emphasises a more holistic approach to understanding behaviour.

The information processing paradigm of cognitive psychology views that minds in terms of a computer when processing information. However, there are important difference between humans and computers. The mind does not process information like a computer as computers don’t have emotions or get tired like humans.

Behaviourism assumes that people are born a blank slate (tabula rasa) and are not born with cognitive functions like schemas, memory or perception.

The cognitive approach does not always recognize physical (re: biological psychology) and environmental (re: behaviourism) factors in determining behaviour. (

Take part in some Cognitive Research

Be a participant – If you want to take part in some online-based research, here is a link to some data being collected currently. (Univeristy of St Andrews in Scotland)

Applied Cognitive Psychology -Forensic Psychology

Work by Elizabeth Loftus investigating how easily a ‘normal’ memory can be distorted by simple language is one of the most well-known works in Psychology.  However, not exempt for ecological validity issues it is still one of the most stark examples of how memory is malleable and easily altered.  Particularly useful in the realm of Forensic Psychology and the ease in which eye-witness testimony can be falsely relied upon.   Test your knowledge of that research –here.

Watch the video on as Loftus explains how memory is reconstructive

 ‘like a Wikipedia page you can go and change it….but so can other people‘.

Loftus also discusses her research and its real world setting –  a response to all those low ecological validity claims:

Do criminals have a distinct and measurable set of thinking patterns?  Yochelson and Samenow attempted to find out.

Applied Cognitive Psychology – Clinical Psychology

Cognitive Behaviour Therapy (CBT)  is a generic term for a therapeutic approach to psychological disorders developed out of a need for an alternative from the more traditional therapeutic Psychoanalytical approach.  Cognitive Behaviour Therapy aims to restructure thoughts of individuals who are suffering from a range of disorders from anxiety and depression.  Do those suffering from depression have a distinct set of thought patterns – Beck tempted to find out? Have a look at Beck’s research into CBT when compared with Drug therapy. Influential Psychologist Albert Ellis developed Rational Emotive Therapy (RET) in the 1950’s with Psychologist Aaron Beck leading the way for psychotic disorders such as Schizophrenia from the 1970’s.  CBT is also being used to treat ‘insomnia’. 

Have a look at Beck’s research into CBT when compared with Drug therapy.

Below shows the progression from Cognition (thought) to the Behaviour (Actions) that have been reframed by using CBT, comparing the initial ‘faulty’ thinking.  Mindfulness is fast approaching CBT as a preferred method of dealing with anxiety without drug therapy.  And here is an article critiquing CBT as a useful therapy.

                                          Unhelpful                                                                                helpful                      

Thoughts: He/she ignored me – they don’t like me He/she looks a bit wrapped up in themselves – I wonder if there’s something wrong?
Low, sad and rejected Concerned for the other person, positive
Physical: Stomach cramps, low energy, feel sick None – feel comfortable
Action: Go home and avoid them Get in touch to make sure they’re OK

An interesting infographic outlining CBT;


Dysfunctional behaviour; Comparison between the DSM-5 and The ICD-10


THE DSM -5 and the ICD 10 are the most renowned classifications for mental illness used today.  As time goes on there is a ‘convergence’ between the two classification systems, however, there are still some key differences.  The Chinese Classification of Mental Disorders-3  is also becoming a significant force but like the earlier versions of the  DSM tends to be used primarily in its country of origin.  In the article cited below written by Professor Peter Tyrer the notion of a new American project for diagnosis based more on current genetic, neuroscience and behavioural science research called the Research Domain Criteria (RDoC) is discussed.


Tyrer explains ‘The absence of a zone of rarity indicates that the threshold for psychiatric diagnosis is usually arbitrary. When psychiatrists make a decision about a clinical diagnosis they, therefore, have no guidance in deciding on the cut-off point between disease and wellness. Almost all psychiatrists create an artificial boundary between disorder and normality. Increasingly, it has been recognised that a dimensional system of diagnosis is, therefore, superior to a categorical one, but this is only beginning to penetrate into diagnostic systems.

Key question

Does the DSM suffer from ‘Over diagnosis (validity) or does the increase in mental health issues relate to inconsistent diagnosing (reliability) or are people suffering more in  a consistently more competitive and difficult world?

These are the subgroups of disorders where the two systems are similar in their main categorisation;


Here are the key differences between the two systems.


‘The above is cited from an article written by Professor Peter Tyrer who is Chair of the ICD-11 Working Group for the Revision of Classification of Personality Disorders and has also been a member of the DSM–ICD Harmonisation Coordination Group. The fascinating article discussing both the history and issues relating to both the current two systems can be viewed here.

Source; Tyrer P (2014) A comparison of DSM and ICD classifications of mental disorder BJPsych Advances The Royal College of Psychiatrists

Sleep Paralysis; The Psychology of demons, ghosts and aliens…………and zombies…maybe.

“One of the most unexplored regions of art are dreams.” – Fuseli

Demons, ghosts and aliens, in that order, have been reported over 100’s of years as visitors in the night scaring not only children but adults too….are we being visited by those from other worlds and dimensions…or….could there be a simpler explanation?

In the ‘Nightmare’  painting by Fuseli a sleeping woman is visited by nightmarish visions of demons and a horseshead…Are these Freudian symbols of neurosis usually buried deep unconscious manifesting themselves or is there an alternative psychophysiological based explanation?

Sleep Paralysis 

Back to the future; Marty Mcfly wakes up his young father in the dead of night dressed as an alien

During sleep it is now well documented that the mind and body goes through a number of processes, the most well known is R.E.M  (and some stages of NREM) where the brain becomes active and where reports of dreaming tends to have the greatest level of frequency.  During this period the human body responds with its own sets of changes, one being the muscles become inactive and it is though that this is a mechanism to stop the dreamer acting out their dreams. This safety mechanism however can sometimes be out of synch hence phenomenon such as sleepwalking and even sleep-murder in rare cases.  During a period of where the body still thinks it is asleep and therefore paralysed  however the individual becomes conscious they can experience a dream like state whilst awake – an experience that is reportedly very frightening, especially as it is correlated with a crushing sensation on the chest from the inhibited muscle activity (back to the demon sat on the woman in Fuseli’s painting).

It was like nothing I’d ever experienced before,” recalls Hannah Foster from Brighton. “After a normal day at work, I went to bed around 11pm, as always, and the next thing I remember is waking up, basically paralysed.  It was terrifying. And the more I panicked, the more it felt like I couldn’t breathe properly.  The second time, I knew what was happening – but as well as the paralysis, I also saw a terrifying black figure.  It looked a bit like a demon – with a scrunched, ugly face, like a gargoyle. I tried to scream and move away from it.”  Source; Mail online

These hypnopompic hallucinations have been correlated with a timeline, those reporting the phenomenon 200 years ago would report demons or ghosts, whilst these still occur attempted alien abduction reports are now more common and represents fears that are culturally time bound.   In Canada the phenomenon is referred to as ‘The hag‘, in Mexico “Dead person on you” (Subirse el muerto) and in China “Ghost pressing down on you‘. Alien abduction attempts have also been explained as examples of traumatic sleep paralysis episodes.  It is interesting to note that you can now get ‘alien abduction insurance‘  for peace of mind.

The future of sleep paralysis experiences 

The Zombie apocalypse is a common theme in television, film and popular culture maybe we will see a rise in zombie related experiences in the dead of night where unsuspecting sleepers wake awkwardly with hypnopompic hallucinations to the face of an extra from ‘The walking dead’, a White Walker from Game of Thrones or the new revamp of the X-Files.