This essay contains two parts which is Abnormal Psychology and sociology of the family. In the first part, the writer will discuss ”the principle difficulties which arise from the diagnosis and treatment of anxiety disorders”, with respect to abnormal psychology. The writer will pay a particular attention to defining abnormality and anxiety disorders, and relevant treatment used to the treat anxiety disorders. Also strengths and limitations each listed treated have and make recommendations were necessary. In page 7 which is the sociology and the family part, the writer will also discuss ”some of the principle issues which arise from the diagnosis and treatment of anxiety disorders”, the writer will concentrate in defining sociology and the family, difficulties which arise from the diagnosis and treatment of anxiety disorder. Then how a Social Care Worker could help their Service Users alleviate their pain and agony when diagnosed with one or more of the anxiety disorders. Finally, the writer will discuss the Mental Health Act (2001) and the stigma attached to those afflicted with mental health issues and psychological disorders.
Judgement about where the line between normal and abnormal should be drawn differently depending on the time and the culture. In the 1960s, a woman who decided to forsake marriage and children in favour of a career in engineering would have been seen by many segments of the society, including some psychiatrics, psychologists, as deviant and possibly in need of psychotherapy. Today, most people would regard the woman’s choice as a valid one (Passer & Smith, 2001:589). In certain Hispanic cultures, a woman who loses a loved one exhibits a range of symptoms that would merit a diagnosis of major depression in the United States. However, in Ecuador, she would be viewed not as psychologically disturbed, but as suffering from susto, or ”soul loss” a normal bereavement pattern that quickly subsides after a mourning ritual designed to help the person deal with the loss (Goleman, 1995 cited in Passer & Smith, 2001:589).
Abnormality is, in the final analysis of social construction (Neimeyer, 1995 & Raskin, 2000). However, abnormal behaviour is ”a behaviour that is personally distressful, personally dysfunctional, and/or so culturally deviant that other people judge it to be inappropriate or maladaptive” (Neimeyer, 1995 & Raskin, 2000, Gamwell & Tomes, 1995, cited in Passer & Smith, 2001: 589-590). While normal fear is adaptive and prevents people from entering threatening situations, with anxiety disorders people develop irrational fear of situations which do not threaten their survival. They also develop maladaptive behavioural pattern associated with anxiety disorders, their fears are accompanied by intense psychological arousal which is shown by the presence of some of the following; sensation of shortness of breath; feeling of choking; chest pain; the person may also experience dizziness, derealisation (feeling of unreality); or depersonalization (being detached from the self) (Carr, 2001: 38).
The Diagnostic and Statistic Manual of Mental Disorders, Fourth Edition (DSM-IV), is the most widely used diagnostic classification system in the United States. For each of its more than 350 diagnostic categories, DSM-IV contains detailed lists of observable behaviours that must be present in order for a diagnosis to be made. The DSM-IV allows diagnostic information to be represented along a five dimensions that take both the person and his or her life situation into account (Passer & Smith, 2001:591). As stated by Carr, (2001:39), within the DSM-IV, 10 distinctions are made between variety of different anxiety disorders based on the developmental timing of their emergence, the classes of stimuli that elicit the anxiety, the pervasiveness and the topography of the anxiety response, and the role of clearly identifiable factors in the etiology of the anxiety. The following are the principal anxiety disorder describe in the DSM-IV; Separation Anxiety; Phobias; Generalised Anxiety Disorder; Panic Attack; Post-traumatic Stress Disorder; Obsessive-compulsive Disorder.
According to Passer & Smith (2001) anxiety responses have three components; a cognitive component, including subjective feelings of apprehension, a sense of impending danger, and a feeling of inability to cope; a physiological responses, including increased heart rate or blood pressure, muscle tension, rapid breathing, nausea, dry mouth, diarrhea, and frequent urination; and a behavioural responses, such as avoidance of certain situations and impaired task performance (Noyes & Hoehn-Saric, 1999; cited in Passer & Smith 2001: 594). Therefore, a large-scale population studies indicate that anxiety disorders are the most prevalent of all psychological disorders in the United States, affecting 17.6 percent of Americans during their lifetime (Kessler et al., 1994; Robins & Reiger, 1991; Satcher, 1999; cited in Passer & Smith, 2001:594).
The predisposition of anxiety disorders may be based on abnormalities in the neuron transmitter system. Excessive activity of norepinephrine in certain parts of the brain has been linked with panic disorder, and excessive serotonin has been associated with obsessive-compulsive disorder (Gorman et al., 1989; Lickey & Grodon, 1991; cited in Bernstein et al; 1997:504). In addition, there is evidence that anxiety-generating neural impulses may run unchecked when the neurotransmitter GABA is prevented from exerting its normal inhibitory influence in certain neural pathways (Friedman, Clark & Gershon, 1991; cited in Bernstein et al; 1997:504).
According to Kring et al; (2010), the German Health Interview and Examination Survey indicated that women are at least twice as likely as men to be diagnosed with an anxiety disorder (de Graaf et al., 2002; cited in Kring et al., 2010:128). Meanwhile, people in every culture seem to experience problem with anxiety disorders. But the focus of these problems appears to vary by culture (Kring et al; 2010:130). However, biological factors state that genes may predispose some people to anxiety disorders. Research indicates, for example, that if one identical twin has an anxiety disorder, his/her co-3twins is more likely to have it than is the case of non-identical twins (Torgersen, 1983; cited in Bernstein et al; 1997:504).
Only a small proportion of people with anxiety disorder seek treatment. Although public awareness campaigns and pharmaceutical company advertising have increased treatment seeking, a community survey of 5,877 individuals suggested that fewer than 20 percent of people with anxiety disorder receive minimally adequate treatment (Wang, Demler, & Kessler, 2002; cited in Kring et al., 2010:145).
In the medical model, antidepressants such as Prozac, Anafranil, Luvox, are classified as stimulants and were also introduced in the 1950s. As well as treating depression, they have been used in the treatment of anxiety, agoraphobia, obsessive-compulsive disorder (Hamilton & Timmons, 1995 cited in Gross & McIlveen 2003:3). The side effect requires adherence to a special diet. Amine-rich food (such as some cheese, pickled herrings and yeast extracts) must be avoided. Failure to do so results in the accumulation of amines, which causes cerebral haemorrhage. Anxiolytics such as Valium, Librium, Xanax, and BuSpar, are known as anti-anxiety drugs, or minor tranquillisers. They are used to reduce anxiety and tension in people whose disturbances are not severe enough to warrant hospitalisation. In 1977, 8000 tons of benzodiazepines were consumed in the USA, and 21 million prescriptions issued in Britain alone in 1989 (Rassool & Winnington, 1993). The side effect includes drowsiness, lethargy, dependence, withdrawal, toxicity (Rassool & Winnington, 1993; cited in Gross & McIlveen 2003:3-6).
Bernstein et al., (1997), states that there are significant differences among members of various ethnic groups and between men and women in terms of psychoactive drug necessary to produce clinical effects. Some studies suggest that female may maintain higher level of therapeutic psychoactive drugs in their blood, show better response to neuroleptics, but experience more adverse effects such as tardive dyskinesia (Yonkers et al., 1992). It is believed that hormonal and body composition difference (such as the ratio of body fat to muscle), among other factors, may be sources gender differences in drug (Dawkins & Potter, 1991; Yonkers et al., 1992 cited in Bernstein et al., 1997: 562)
A long lasting criticism of the medical treatment is that the drug based therapy only alleviate symptoms in short term and do not address the underlying causes of emotional and psychological distress. Also they do not consider people’s culture and ethnic background when assessing their psychological disorders and prescribing their medications.
Cognitive-behavioural theories of anxiety disorders points to the importance of learning experiences in their development (Carr, 2004:67). In behavioural therapy, psychodynamic and phenomenological approaches assume that if clients gain insight or self-awareness about underlying problems, the symptoms created by those problems will disappear. They try to help clients view psychological problem as learned behaviour that can be changed without first searching for hidden meanings or underlying processes (Bernstein et al., 1997: 540). Some of the most and commonly used behavioural treatment techniques are systematic desensitization; a behavioural treatment often used to help clients deal with phobias and other form of irrational anxiety was developed by Joseph Wolpe (1958). A method for reducing intense anxiety in which the client visualizes a graduated series of anxiety-provoking stimuli while maintaining a state of relaxation. Wolpe believed that this process so weakens the learned association between anxiety and the feared object that the fear disappear (Wolpe, 1958; Bernstein et al., 1997: 542).
Modelling; therapist often teach clients desirable behaviours by demonstrating those behaviours. In modelling, the client watches other people perform desired behaviours, thus vicariously learning skills without going through a lengthy shaping process. In fear treatment (Phobias), modelling can teach client how to respond fearlessly while vicariously extinguishing conditioned fear responses. Flooding; in flooding, the person is forced to confront the object or situation eliciting the fear response. For example, a person with a fear of heights might be taken to the top of a tall building and physically prevented from leaving. By preventing avoidance of, or escape, the feared object, the fear response is eventually extinguished (Gross & McIlveen 2003:36). However, implosion therapy; repeatedly exposes the person to vivid mental images of the feared stimulus in the safety of the therapeutic setting. This is achieved by the therapist getting the person to imagine the most terrifying form of contact with the feared object using stimulus augmentation. After repeated trials, the stimulus eventually loses its anxiety-producing power and the anxiety implodes because no harm comes to the individual in the safe setting of the therapist’s room (Gross & McIlveen 2003:36).
Although implosion and flooding are effective with certain types of phobia (Emmelkamp et al., 1992). However, for some people, both lead to increased anxiety, and the procedures were too traumatic. (Emmelkamp et al., 1992; cited in Gross & McIlveen 2003:37). Therapies based on operant conditioning; involves three main steps. The first is to identify the undesirable or maladaptive behaviour. The next step is to identify the reinforcers that maintain such behaviour. The final step is to restructure the environment so that the maladaptive behaviours are no longer reinforced; example would be OCD (Gross & McIlveen 2003:43).
Criticism of the behavioural therapy is that they focused only on disorder’s observable aspect; they fail to identify its underlying causes. One of the consequences of this is system substitution. They only consider the maladaptive behaviour to be the disorder, and the disorder is ”cured” when the behaviour is changed. Although critics accept that such therapies can be effective, they see therapist as manipulating, dehumanising, and controlling people and depriving them of their freedom. Therapists see themselves as helping people to control their own behaviour. On the other hand, supporters of the behavioural model argue that they do not treat disorders without consent and that, in a sense, we are all ”naive behaviour therapist”. For example, when we praise people for a particular behaviour, we are using behaviour modification techniques: all therapists are doing is using approaches in a systematic and consistent way (Gross & McIlveen 2003:50-2).
All cognitive approaches have one thing in common. They emphasize that how people construe themselves and the world is a major determinant of psychological disorders. By changing cognition, therapists hope that people can change their feelings, behaviour, and symptoms. In cognitive therapy, the therapist typically begins by helping clients become more aware of their maladaptive behaviour thoughts. Therefore, the root of cognitive therapy included Beck’s cognitive therapy and Ellis’s rational-emotive therapy (Kring et al., 2010:494). Beck’s bases his approach on the idea that negative cognitive patterns are maintained by errors in logic and erroneous beliefs such as ”I can’t do anything right”, or by value minimizing thoughts such as ”Anyone could do that’. These thoughts and beliefs, in turn, lead to low self esteem, depression, and anxiety (Bernstein et al., 1997:545).
The first stage of the therapy is for people to recognise and question their irrational beliefs rather than remaining ‘anonymous’. Once people have recognised and analysed their beliefs, they are taught to substitute more realistic alternatives to engender full acceptance. Rather than measuring themselves against impossible standards, a RET emphasises that failures should not be seen as ‘disastrous’, confirming a lack of self worth, but merely as ‘unfortunate’ events. Although, RET seems to be very effective for some types of anxiety disorder (Emmelkamp et al., 1978). However, for other disorders (such as agoraphobia) RET is less effective than therapies derived from other models (Haaga & Davison, 1993) (Emmelkamp et al., 1978; Haaga & Davison, 1993; cited in Gross & McIlveen 2003:58).
Criticism of therapy based on cognitive model have received considerably scrutiny as their worth (Andrews, 1993). Cognitive therapies can be particularly helpful in the treatment of panic disorder. However, they have also been shown to have significant impact on many medical conditions and to reduce the psychological impact of unemployment. Their usefulness in the treatment of other disorder is less clear-cut (Andrew 1993; cited in Gross & McIlveen 2003:66).
Sociology according to Donohoe and Gaynor (1999:149) is ‘the scientific study of society hat aim to look at the causes and consequences of a social change and the principles of social order and stability’. It requires us to study how people live together, how we co-operate or complete when times are good or when times get tough. ‘Sociology enables us to develop self-awareness and self understanding, facilitating and increased recognition of what enables and constrains our, and others actions’ (McIntosh and Punch 2005:20; Donohoe & Gaynor 1999; cited in McDonald 2009:2). Babbie (1988:4) in his work the Sociological Spirit also states that ‘sociology is also the study of how rules are organised and perpetuated’. While it is important to examine the rules that govern how people live together, we need to examine how they arise and how they change over time. For Bebbie, sociology is also how we break rules and why at times this is not always a bad thing (Babbie 1988; cited in McDonald 2009:2).
Sociology is not just about human societies; it is also a way of thinking about human societies (Hyde, Lohan & McDonnell 2005:6). The American S. Wright Mills emphasised the importance of developing ‘sociological imagination’ and of using it within sociology. Most simply out, ‘the sociological imagination requires us, above all, to ”think ourselves away” from the familiar routines of our daily lives in order to look at them anew’ (Giddens 2001:2 cited in McDonald 2009:3). Mills ‘held up sociology as an escape from the ”traps” of our lives because it can show us that society-not our own foibles or failings-is responsible for many of our problems’ (Macionis and Plummer 20005:10). He argued that the sociological imagination allowed people to understand their ‘private troubles’ in terms of ‘public issues’ (Haralambos & Holborn 2004:xxv; Macionis & Plummer 2005; cited in McDonald 2009:4).
Family is defined as ‘any combination of two or more persons who are bound together by ties of mutual consent, birth, and/or adoption or placement and who together, assume responsibility for, inter alia, the care and maintenance of group members through procreation or adoption, the socialisation of children and the social control of members’ (UN, cited in Honohoe and Gaynor 2003:242; cited in McDonald 2009:80). Family is regarded as one of the most basic and important institutions in society because it is where society is reproduced in its most basic form-the individual. All societies contain some form of family arrangement. Several decades of research, inquiry and discussion have enabled sociologists to increase our understanding of the family, its changing patterns over time and its role within the wider society (McDonald 2009:80).
‘For many years a great transformation has been taking place both in the structure of the family as a social institution and un the nature of relationships among family members’ (Curry et al., 2005:312). ‘The major difference which engaged sociological research and debate concerns the transition from a predominately extended family in pre-industrial times to the nuclear or conjugal family typical in modern industrial society’ (IPA 1992:34; Curry et al., 2005; cited in McDonald 2009:81).
When a condition is misdiagnosed as anxiety disorder, treatment will be ineffective and often makes things worse by delaying treatment of the underlying illness. Sometimes, doctors/therapist does not always get all the information necessary to make a correct diagnosis or make treatment decisions. Reason being that many people feel shame over things in their past; think that they will not treat them if they had substance abuse problem; are embarrassed by their thoughts; believe they will be judged if they reveal they are HIV positive; are concerned about what will be written in the medical record; and so on (Amen and Routh 2003:283).
According to Amen and Routh (2003), anxiety and depression affect the whole family and often cause serious problems. We have seen ”caring” families fall apart because of the turmoil these illnesses generate. We have also seen divorces between people who ”truly loved each other” because of the stress of one or both partners having a mood or anxiety disorders. In addition, these illnesses tend to have a strong genetic component, meaning that if a parent has one type of anxiety disorder, there is high probability that one or more of their children will have it as well. The stress can break families apart following many different sources such as; social isolation, misperception, lack of emotional expression, easily frustrated/emotional/moody, tantrums/rage outburst, low self-esteem, chronic tension, failure to see other’s side, low energy, lack of interest in usual activities or sex, and finally lack of production (Amen & Routh 2003:260-22).
As stated by Amen & Routh (2003), many people with anxiety disorder have struggled in their relationships to avoid experiencing pain again; they avoid relationships or make excuses to be by themselves (social isolation). In addition, automatic negative thoughts (ANTs) often cause them to put a negative spin on their past relationships so they are less likely to seek relationships in the future. Couple with stigma attached to people with anxiety disorders, they find it very difficult to move forward or bounce back (resilience) after a relationship/marriage breakdown due to the illness. This can be as a result of lack of help or support from family member or partners as well. Misperceptions often cause serious problem in relationships. Sometime the spouse or parent of a person afflicted with anxiety disorder has to spend an inordinate amount of time correcting misperceptions that lead to disagreements. Labelling theory provides important insights into the stigma of mental illness, and the distinct possibilities that exist for negative labels to amplify and compound the conditions of mental illness when an individual is excluded from alternatives social roles (Hyde et al., 2006:188).
According to Amen & Routh (2003) the stigma attached with ”mental illness” prevents many individuals from attaining assistance. People do not want to be seen crazy, stupid, and do not seek help until they can no longer endure the pain. Men are especially affected by denial. Many teenagers also resist getting help even when faced with understandable problem. They worry about label and do not want yet another adult judging their behaviour.
With lack of production, a person with anxiety disorder may be unable or less able to work or do household chores. This put an extra burden on other family members, who may feel resentment if they do not understand these illness (Amen & Routh 2003: 262). If a spouse has being working and due to one reason or the other loses his or her job, the person might develop anxiety because of the job loss. The partner or members of the family might seem to be offensive due to the behaviour exuberance and the children might not understand why they are acting in that manner. It can affect the family function/dynamic because the person might not be as productive as he/she used to be. In this regards, Mental Health Act (2001), authorise a guardian to make an involuntary admission to approved centres of children and adult if suspected of behavioural intolerance and if the person certify the criteria of admission. A Social Care Worker can act as a guardian/advocate to service users whose anxiety disorders are preventing them from reaching their full potential, for example being unemployed and not participating in the environment he/she is living.
Irish children with severe mental health conditions are still being admitted to adult psychiatric hospitals where there is no specific treatment for them, a conference in Galway heard at the weekend. Consultant child and adult psychiatrist Dr Kieran Moore said that although this practice was due to end by December 2011 under an amendment to the Mental Health Act 2001, 15- and 16-year-old children were still being treated in this way. Only 7 per cent of our total health spend is spent on mental health and there is the whole stigma around mental illness,” he said. “Vision for Change, the Government’s blueprint for mental health service provision over the next seven years, contains very good recommendations, but we are way behind in implementing these and the economic situation is not helping,” he commented. Conditions such as anxiety, depression, eating disorders, autism spectrum disorders and schizophrenia caused huge distress, not only for the child who was diagnosed with the illness but for their parents and wider family, Dr Moore said (McDonagh, 2010).
They can be easily frustrated/emotional/moody. Many family members with of anxious children, teens, and adult have said that they never know sometimes what to expect from the person. ”One minute she’s happy, the next minute she’s screaming” is a common complaint. Small amount of stress may trigger huge explosion. People with anxiety disorder develop low self esteem, when they do not feel good about themselves; it impairs their ability to relate to others. They have difficulty accepting compliment or getting outside themselves to truly understand another person. Many partners of patients with anxiety disorder complain that when they give their partner compliment, they found a way to make it look like they have been criticised (Amen & Routh 2003:260-22).
Carr (2004) states that there is no well-articulated, integrative theory about the role of the family and the socialization process in the etiology of anxiety. Individuals probably develop anxiety problems when they are socialized in families where significant family members (particularly primary caretakers) elicit, model and reinforce anxiety-related beliefs and behaviours. Furthermore, family lifecycle transitions, such as staring school, moving house, birth of a sibling, illness, and stressful life events within the family may precipitate the onset of clinically significant anxiety problems. These problems are maintained by patterns of family interaction that reinforce the individual’s anxiety-related beliefs and avoidance behaviour (Carr 2003:69). Often families fall a victim to undiagnosed or untreated anxiety disorder, according to Amen & Routh (2003), involving the whole family in the treatment is often essential for a healthy outcome.
When there is a communication issues, there is a tendency to misinterpret information, react prematurely, or have emotional outbursts over real or imagined sights. It is essential to teach families how to listen, clarify misunderstandings, and avoid mind ready. It is also essential to teach families how to communicate in a clear, emotional manner. Guilt is an issue for many families as they show resentment; bad feelings, and anger which are common with family members. Yet they feel they are not ”supposed” to have those behaviours towards people they love and are abandoned by feeling of guilt. It is essential to teach family members that these resentments are normal given the difficulties of the situation. Explaining the biological nature of the illness to family members often helps them understand the turmoil and be more compassionate toward the suffering person, while alleviating any guilt they might feel. In divorced families anxiety or mood disorders are very common. This may be due to many factors, such as increased family turmoil or substance abuse. Thus, the issues of divorce, custody, and stepfamilies often need to be addressed in the treatment (Amen & Routh 2003:262-4).
However, men are often the last people to admit that there are emotional or family problems. They often delay treatment, for their children or themselves, until there had been a negative effect on self-esteem or functioning. Whatever reason, men in the families need education about anxiety disorder, and need to be part of the treatment process for the best chance of success. Men are more competitive than women and need encouragement. To this end, it is important for wives, mothers, social care worker, and therapist to engage fathers in a positive way and encourage them to see their valuable role in helping the whole family heal (Amen & Routh 2003:264-5).
SCW and therapist can clearly explain to them that they know they are trying their best, but their actions, judgments or beliefs may be getting in the way of their achievement (at work, in relationships, or within themselves). Give them information, for example, books, videos, and articles on the subjects you are concerned about can be of remarkable help. Protect your relationship with your patient/client, people are more receptive to those they trust rather than those who nag and belittle them. Most people do not let anyone tell them something bad about themselves unless they trust the other person. Work on gaining the person’s trust over a long run. It will make them more receptive to your suggestions. Do not make getting help the only thing you talk about. Make sure you are interested in their whole live, not just their potential medical appointments (Amen & Routh 2003:267-8).
I personally think that the Mental Act (2001) should be reviewed and if necessary updated with recent recommendations found in mental hospitals and children with severe mental illness should be removed from adult mental hospital and place where their needs will be meet accordingly as stated above that the removal will be due following amendment from the MHA (2001).
In conclusion, the line between whether a person is normal or abnormal should be drawn from the circumstances or the problems they are facing at that particular time not just putting people in a box and give them a name or label them because they do fit in with us. We have seen in the previous pages the difficulties with diagnosing people with anxiety disorder and the treatment options they can get to manage their anxiety both in abnormal psychology and the sociology and the family. However, these treatments have negative and positive effect on the patients/service users who are receiving it, especially the medical model of treatment because they only care about giving patients pills to alleviate their pain and again it is not as expensive and time consuming as other treatments such as Cognitive therapy, and Behavioural therapy as mentioned above, patients tend to sorcome to their treatment.
It is very important that a social care worker understands that depression and anxiety disorder can break families apart following many different sources such as; social isolation, misperception, lack of emotional expression, easily frustrated/emotional/moody, tantrums/rage outburst, low self-esteem, chronic tension, failure to see other’s side, low energy, lack of interest in usual activities or sex, and finally lack of production (Amen & Routh 2003:260-22). However, they can help service users and their families afflicted with it to seek help from therapist and encourage the whole family to participate in all sessions involved.