Conceptual frameworks and research findings relevant to mental health and mental disorders of adults and elderly will be discussed. Biological and psycho-social frameworks and findings will be examined from an evidence-based point of view. The promotion of health and the prevention of various mental disorders will be examined. The classification (diagnosis), etiology, treatment, rehabilitation and prognosis of mental disorders will be discussed. Various factors which modify mental disorder such as socio-economic status, race, ethnicity, gender, sexual orientation, physical disability, and age will be considered. The impact of these factors on symptomatology, social functioning, quality of life and prognosis will be discussed. The relationship of people with disorders to their families, caregivers and others in supportive and regulatory roles will be explored.

Course Content

The Diagnostic and Statistical Manual (DSM IV) system of classifying behavior will be compared with other classification systems such as Person in Environment (P.I.E.). It will also be compared with other social work and social science approaches to assessment, particularly those focusing on social functioning rather than disorder. The reliability of the DSM-IV system; the usefulness of the system for the purposes of promotion, prevention, treatment or rehabilitation will be discussed as will the connections to social work and social science constructs. The disorders to be considered include schizophrenia and other psychotic disorders, mood disorders, personality disorders, anxiety disorders and mental disorders of aging. The prevalence of these disorders will be considered with particular reference to their distribution according to such factors as socio-economic status, race, ethnicity, gender, sexual orientation age and physical disability. Studies exploring the influence of biological factors on the development of these disorders will be examined. Also to be examined is the response of these disorders to a variety of medications and to nonpharmacological somatic treatments, such as electroconvulsive therapy (ECT), bright light treatment, sleep deprivation, or repetitive Transcranial Magnetic Stimulation (TMS) Likewise studies exploring the influence of environmental factors in the development, precipitation, recurrence and persistence of these disorders will be considered. Also to be considered is the appropriateness of various psychosocial services including psychotherapy/counseling, residential, vocational, social, educational, and self-help and mutual aid programs for people with various types of mental disorder.

The role of families and community caregivers in supporting individuals with these disorders will be addressed. Similar attention will be given to identifying family and environmental factors that may be amenable to modification, thus preventing relapse. Special attention will be given to understanding the processes by which stigma arises and is perpetuated.

The potential of the mental disorder classification system to create deviance will be examined. Misuses of the system and their negative consequences will be discussed especially as they fall disproportionately on persons who are "minorities" including women, racial and ethnic minorities, LGBT persons, persons with primary medical conditions and persons of low socio-economic status. Strategies for avoiding these misuses will be discussed. Concerns about the ethically questionable uses of the DSM-IV system to influence eligibility or reimbursement for services will be discussed.

Prevention will be discussed in relation to each of the disorders. For example, obstetric difficulties will be discussed in relation to schizophrenia, race in relation to the misdiagnosis of bipolar disorder, loss in relation to depression and dysthymia, and violence in relation to post-traumatic stress syndrome. Web sites will be used to obtain information about the disorders and their treatment as well as about the social justice and change goals and activities of family advocacy and consumer support and empowerment groups. A comprehensive site with numerous links to other sites is http://www.mentalhealth.com/.

Course Themes:

Multiculturalism and Social Diversity will be addressed through discussions of different patterns of health promotion opportunities and diagnosing practices affecting diverse cultural groups including women, racial and ethnic minorities, persons with variant sexual orientations, persons with other primary medical conditions and persons of low socio-economic status.

 

The anthropology of the last few decades can be characterized by a tension between descriptions of the world in which people find themselves embedded and the independence with which they buck the system.

This is perhaps the serious philosophical issue in anthropology: Is the self culturally constituted, or are we free? Anthropologists used to specialize in explaining how culture shaped the way people were, how culture’s web of meaning profoundly formed the way people thought and felt and moved. Then--embarrassed that calling attention to cultural differences could make those differences seem rock hard--they became interested in the way individuals acted in and against their culture to change it. Desperate to see social life as something people make and use, some anthropologists even abandoned the word "culture" altogether; they say that they write "against culture," beyond culture," to "forget culture." (Tanya Luhrmann, Review of Sherry B. Ortner Making Gender, NYT Book Review, 11/24/96.

Social Justice and Social Change will be addressed through examination of the discrimination experienced by people with mental illness, particularly those from disadvantaged groups. The social justice and social change agenda of family advocacy and consumer support and empowerment groups will be examined as a source of information about needed social changes.

Behavioral and Social Sciences Research will be addressed through the review of epidemiological studies dealing with the frequency and distinguishing characteristics of those who experience particular disorders; controlled trials of various interventions including medication, intensive outreach services, social skills training and psychoeducational services; and follow-up surveys of persons affected by the disorders.

Promotion, Prevention, Treatment and Rehabilitation will be addressed through the following means: Epidemiological studies of the influence of, for example, poverty on the incidence and prevalence of particular disorders will be reviewed for their promotion and prevention implications. Prevention will also be addressed by an examination of the avoidable negative social consequences of severe mental illness, e.g. homelessness, joblessness, and disrupted educational careers. Prevention, still further, will be considered from the point of view of averting their occurrence by early intervention. Treatment will be discussed in terms of the clinical efficacy and service effectiveness of various interventions. Rehabilitation will be considered in the context of the effectiveness of various residential, vocational, social and educational services for people with mental disorders.

Values and ethics will be addressed through the emphasis placed on working on behalf of the most disadvantaged persons with mental disorders. It places special value on advocacy and environmental modifications. The potential harm associated with classification is discussed as are ethically questionable practices that have arisen as the DSM-IV has been embedded in insurance reimbursement and service eligibility policies.

Course Objectives:

Students should be able to:

1. Compare and contrast the utility of the mental disorders diagnostic system with broader social work and behavioral science frameworks focusing on social functioning.

2. Discuss the bio-psycho-social aspects of the disorders below in terms of clinical

presentation, prognosis, etiology, prevention, treatment, and rehabilitation.

a. schizophrenia and other psychotic disorders

b. mood disorders (including major depression, bipolar disorder, and dysthymia)

c. personality disorders (including anti-social and borderline personality disorders)

d. anxiety disorders (including obsessive-compulsive, panic and post traumatic stress disorders, and phobias)

e. mental disorders of aging (including Alzheimer’s and other dementias).

3. Discuss the impact of culture and race on the disorder and the person with the diagnosed with the disorder

4. Discuss the potential of the mental disorder classification system to generate deviance and discuss strategies to minimize those risks and to combat stigma.

5. Discuss the appropriate use of diagnostic/classification systems and the ethical questions surrounding the use of this symptoms.

6. Distinguish empirically based generalizations about mental disorders from clinical wisdom or authoritative opinions, and demonstrate ability to use the scientifically based literature in search for solutions to problems.

Course Assignments:

Please come to class having done the readings and prepared to discuss the questions on the course schedule. Regular attendance is expected. Please e-mail me if you anticipate an unavoidable absence. No explanations are necessary. However, I can give you some guidance about how to "makeup" the session but please note, I will not be able to loan you personal copies of videos.)

Required:

American Psychiatric Association. (1994). Diagnostic Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Washington, D.C.: author. $49.95

Bernheim, K. F. (1997). The Lanahan Cases and Readings in Abnormal Behavior. Baltimore: Lanahan Publishers. $25

Coursepack: Dollar Bill's 611 Church St. 665-9200

Recommended

Seligman, L. (1998). Selecting effective treatments: A comprehensive, systematic guide to treating mental disorders. San Francisco: Jossey Bass. $39.95

Books are available from Ulrich’s Bookstore, Michigan Union, and Michigan Book and Supply

1) Intervention and multicultural factors in mental disorder: Select one of the following disorders as the topic for your paper: a) schizophrenia, b) major depression or bipolar disorder, c) borderline personality disorder or antisocial personality disorder, d) generalized anxiety disorder or posttruamatic stress disorder. (If you would like to work on another disorder, let’s talk.) Discuss this disorder from the point of view of intervention which is defined to include one of the following: treatment, rehabilitation or prevention. Also discuss the impact of any one of the following factors on the disorder: gender, age, poverty, sexual orientation, ethnicity, race, or ethical considerations.

Thus, for example, you might do a paper on the prevention of anxiety disorders among gay males. Or to take another example, a rehabilitation plan for an elderly person with schizophrenia.

Illustrate your ideas with observations from your experience (including your practice) or from fiction or first-person accounts. The paper should not attempt to provide comprehensive coverage of the disorder but only coverage of the cultural and intervention aspects you selected. The assignment will be discussed in class in order to stimulate your thinking about which aspect of intervention and multiculturalism you wish to focus on. The length of the paper should be 5-8 pages and should include 3 references not in the coursepack. Some papers may be selected for classroom presentation; group projects are also welcome (let’s discuss your ideas). (Grade = 25%, due October 14).

2) Clinical Assessment and Treatment Discussion Using either Observations of a Client(s), or Fictional Accounts, or First-Person Accounts, or Ethnographic Observations (e.g., at self-help group meetings) Instructions will be handed out separately. Grade =30%. Due November 18.

3) Final exam: Includes short-answer essay questions on class lectures and discussions, readings, handouts, and earlier assignments. The exam will be available December 10. The exam will be graded according to your knowledge of the concepts dealt with in the class and your ability to integrate and discuss their relevance to practice situations. Due December 16. Grade equals 45% of the course grade.

Assignment Notes: With the exception of the final exam, assignments can be modified to suit your interests. You may also assign different weights to the first two papers. However, it’s important to talk early. The grades should be used to assess your progress in understanding and using the material. However, please remember the grade is not to be interpreted as an indication of your ability or potential as a social worker. The numerical equivalents of the letter grades that will be used to compute the course grade using a spreadsheet (Excel), are: A 4.0, A- 3.67, B+ 3.33, B 3.0, B- 2.67, C+ 2.33, C 2.0, C- 1.67; very rarely A+ 4.33.

Please do not put papers in folders as they are easier to handle without them. Late assignments will be graded down one level (e.g. B+ to B) and will not receive comments except where arrangements have been made well in advance.

Preliminary Course Schedule