History of Treatment

Care as a social issue -- the history of treatment What to do with the severely disturbed? –middle Ages to 17th century madness = in league with devil torture, hanging, burning, sent to sea –18th century mentally disordered people = degenerates keep them away from society –19 th century moral-treatment movement kindly care led to large, state-supported public asylums

The 20th century Deinstitutionalization (mid-1950s) –get people out of asylums and back into community –effective antipsychotic medication –general mood of optimism in country 1961: establishment of community mental health centers

Hospitals from a patient's perspective Rosenhan (1973): "On being sane in insane places” –sane people got into mental hospitals as patients –found very low interaction with staff –dehumanizing nature of interactions –normal behaviors interpreted pathologically There are successful inpatient & outpatient treatment programs

Places of treatment public or private mental hospitals general hospitals nursing homes for older patients with mental health needs halfway houses/group homes community mental health centers private offices

Providers of treatment Psychiatrists –medical degree (M.D.) –special training/residency in psychiatry –mainly hospitals & private practice –can prescribe drugs Clinical psychologists –doctoral degree (Ph.D.) in psychology –training in research & practice –universities, private practice, community mental health

Providers of treatment Counseling psychologists –doctoral degree in psychology –sometimes more emphasis on practice than research –problems of living, rather than diagnosable conditions Counselors –master's degree in psychology –schools & institutions –school-or job-related problems

Providers of treatment Psychiatric social workers –master's degree in social work –public agencies, home visits Psychiatric nurses –bachelor's or master's in nursing –hospital settings Self-help groups –Alcoholics Anonymous –Overeaters Anonymous

Recipients of treatment Most people who meet criteria for DSM diagnoses do not seek treatment Variability due to sex, education, race & income level –women seek more treatment than men –college educated seek more treatment than high school educated –whites seek more treatment than nonwhites –higher income seek more treatment than lower income