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Biological treatments of abnormality and mental illness

Act directly on the biological mechanism responsible for the abnormal behaviour

Drugs (antidepressants, antipsychotics, anxiolytics)

ECT (Electro convulsive therapy)

Psychosurgery

Treat symptoms more than causes




Biological treatments of mental illness and abnormality
Biological treatments act directly on the biological mechanisms that cause, or are involved in, mental illness. This can be, for example, by altering the function or availability of a neurotransmitter, changing the way certain cells in the nervous system function, or removing dysfunctional parts of the nervous system. The three main biological treatments for mental illness are:
  • Drug treatments
  • Electroconvulsive therapy
  • Psychosurgery

Drug treatments
Drugs that have been found to usefully treat mental illnesses generally work by changing the amount of a neurotransmitter that is available at a synapse. If, for example, a certain neurotransmitter causes a certain behaviour then stopping the neurotransmitter working, by making less of it available, may reduce the behaviour it causes. Similarly, it may be useful to increase the quantity of a certain neurotransmitter so the the behaviour it affects may be increased.
  • Serotonin is a neurotransmitter that has been found to be involved in depression. A class of drugs called SSRIs (selective serotonin reuptake inhibitors) work by stopping nerve cells reabsorbing the serotonin they have released into the synapse, thereby increasing the amount of serotonin that is available. SSRIs are a very effective treatment for depression and include drugs such as Prozac (fluoxetine) and Seroxat (paroxetine).
  • Benzodiazepine drugs are commonly used to treat stress, anxiety and high blood pressure. They work by blocking receptors that are usually activated by adrenaline and noradrenaline, meaning that the body is less able to produce extreme and unhealthy sympathetic nervous system responses.
  • Another class of drugs that work on noradrenaline synapses is monoamine oxidase inhibitors (MAOIs). These stop the enzyme monoamine oxidase breaking down noradrenaline, and therefore increase the amount of noradrenaline that is available at the synapse. Low levels of noradrenaline in certain areas of the brain has been linked with depression, and so MAOIs are an effective antidepressant.
  • Antipsychotic drugs, which are often used to treat schizophrenia, work by reducing the amounts of dopamine at synapses in certain areas of the brain.

Evaluating drug treatments
  • Drug treatments have been found to be effective in treating many many illnesses, and in many cases the improvement seen is very quick (e.g. antidepressant drugs may relieve many of the symptoms of depression in just a couple of weeks). However, as is argued by Kirsch & Saperstein (1998), much of the benefit may be due to the placebo effect. The placebo effect is where a drug has an effect simply because the patients expects it to, rather than the actual chemicals in the drug.
  • Many drugs have side effects that can, in some cases, be more unpleasant than the illness they are supposed to be treating. Many antidepressants cause nausea, dizziness and even anxiety at first. Antipsychotic drugs may cause movement disorders and tremors. Doctors and patients have to weigh up the possible benefits of using a certain drug against the negative effects it may cause.
  • Drugs are an intervention that treat the symptoms of many mental illnesses and do not address the cause. Antidepressants may elevate a person's mood so they are able to return to a normal life, but they do not necessarily address the cause of the depression, which is often psychological.
  • The use of drugs to treat mental illness raises many ethical concerns, particularly when they are used in mental institutions against a patent's will. Critics have argued that the drugs are not effectively treating mental disorders, but instead are sedating patients to make them compliant and manageable.
Electroconvulsive therapy (ECT)
Electroconvulsive therapy involves applying electrodes to a patient's head and passing an electric current through their brain until they have a convulsive fit. It is, for reasons not properly understood, very effective at treating severe depression in patients that do not respond to antidepressant drugs. In 1999 some 11,000 patients were given ECT for depression in England and Wales.

Evaluating ECT
  • ECT is a quick and effective method of treating severe depression, and is particularly useful when depressed patients are in imminent danger of harming themselves or committing suicide.
  • It is not know how ECT works, but it does seem to increase the levels of certain neurotransmitters in the brain.
  • When ECT was first used there were serious side effects, such as broken bones from the convulsions that the treatment causes. However modern use of the treatment is carried out under anaesthetic and with muscle relaxants so injuries are uncommon. There is often memory loss following treatment, but this has been reduced by only applying ECT to one hemisphere of the brain (unilateral) rather than both hemispheres (bilateral).
  • ECT is a barbaric-appearing treatment that has been used to punish patents in the post. Today it can only be used when other treatment methods have failed, and only when the patient agrees to it. It can be forced upon patients, but only when they are unable to make a rational decision themselves, and only when they are in imminent danger of self harm.
Psychosurgery
Psychosurgery is brain surgery to treat psychological disorders. It is the more invasive form of biological therapy because it involves removal of brain tissue and the effects are irreversible, and sometimes unpredictable. The first modern psychosurgery technique was the pre-frontal lobotomy, developed in the 1930s as a cure for schizophrenia and other disorders where patients were aggressive and unmanageable. Lobotomies involved destroying areas of the pre-frontal cortex that are involved in planning and free will, with the result that lobotomised patients became compliant, less aggressive and easy to control. Modern psychosurgery for mental illness is limited to rare procedures such as anterior capsulotomy in extreme cases of obsessive-compulsive disorder, and the removal of tumours that cause behaviour change.

Evaluating Psychosurgery
  • Psychosurgery is an extremely controversial treatment for mental illness. Before the 1960s it was performed on many thousands of people in an effort to treat otherwise untreatable disorders, and to allow otherwise dangerous patients to leave mental institutions. However, today's treatment methods are so much more advanced that it is almost never necessary to go to the extreme of brain surgery to treat a psychological disorder.
  • If psychosurgery is performed today, it will be as a last resort when all other treatments have failed. However there is some surgery that has far more benefit than others, for example anterior capsulotomy in severe anxiety or obsessive-compulsive disorders.

A Level exam tips
Answering exam questions (PSYA2 AQA A specification)
Outline and evaluate biological treatments of abnormality (12 marks)
6 AO1 marks. Describe drug treatments, with elaborated examples, ECT and psychosurgery.

6 AO2 marks. Write a commentary on the effectiveness of drug treatments as it has the most to discuss. Concentrate on the speed and effectiveness, but that it may work due to the placebo effect, that it does not treat the cause only the symptoms, has side effects, and ethical issues. You could also evaluate ECT as a fast and effective treatment, but that it is not know how it works and has side effects.




cognitive model, cognitive approach, free will, determinism, responsibility for abnormality, faulty thinking, thought processes, cognition, maximisation, minimisation, over generalisation, cognitive errors, cognitive distortions