Stigmatisation in Individuals with Generalised Anxiety Disorder
|✅ Paper Type: Free Essay||✅ Subject: Psychology|
|✅ Wordcount: 5285 words||✅ Published: 8th Feb 2020|
Table of Contents
What is generalised anxiety disorder?
The Mental Health Act (Section 136)
How a counsellor would work with a client
Power threat meaning framework
List of abbreviations
BACP- British Association for Counselling and Psychotherapy in Counselling.
CBT- Cognitive behavioural therapy
DSM- Diagnostic and Statistical Manual of Mental Disorders
GDA- Generalised anxiety disorder
GP- General practitioner
IAPTS- improving Access to Psychological Therapies
PCT- Person centred therapy
Generalised anxiety disorder
Within this report I will be looking at how counsellors would work with an individual who has been stigmatised due to being diagnosed with Generalised anxiety disorder.
What is generalised anxiety disorder?
Anxiety UK states that an individual who has been diagnosed with generalised anxiety disorder will experience anxiety and they tend to worry about situations and events that may occur without a reason (Anxiety UK 2018). They may worry about things such as; money, work, school or relationships (Anxiety UK 2018). An individual who has been diagnosed with generalised anxiety disorder is constantly worrying and it tends to control their lives (Anxiety UK 2018).
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The main cause of generalised anxiety disorder is unknown however there are some factors that can contribute to an individual developing generalised anxiety (Childrenshospital.org, 2018). One of the factors that may contribute could be genetics. Another factor could be temperament factors for example if an individual is timid or shy it is suggested that they are more likely to diagnosed with generalised anxiety disorder (Childrenshospital.org, 2018). Finally, environmental factors such as divorce, illness or a bereavement could trigger the anxiety (Childrenshospital.org, 2018).
- Within the United Kingdom there were 8.2 million people diagnosed with anxiety in 2013 (Mental Health Foundation, 2018)
- Women are two times more likely to be diagnosed with generalised anxiety disorder than men (Mental Health Foundation, 2018).
- There is a 6.6% occurrence of generalised anxiety within the UK (Mental Health Foundation, 2018).
The “Diagnostic and Statistical Manual of Mental Disorders (DSM) is the handbook used by health care professionals. “DSM contains descriptions, symptoms and other criteria for diagnosing mental disorders” (American Psychiatric Association, 2013)
Within the DSM-5 it is stated that an individual needs to meet the diagnostic criteria to be diagnosed with generalised anxiety disorder (American Psychiatric Association, 2013). Here are some of the symptoms within the criteria:
- Extreme anxiety and worry which the individual has been experiencing for minimum 6 months about events and activities (American Psychiatric Association, 2013).
- Difficulties controlling the worry (American Psychiatric Association, 2013)
The anxiety and worry need to be linked with three or more of the following symptoms (American Psychiatric Association, 2013). The individual must have been experiencing some of these symptoms a minimum a few days:
- Getting tired easily
- Lack of concentration or having mental blocks
- Muscle tension
- Sleep difficulties
(American Psychiatric Association, 2013)
Counsellors are aware of the DSM and the criteria it has for each diagnosis however they don’t use it as it doesn’t look at the clients experiences it focuses more on symptoms. Also, there is a high percentage of individuals being misdiagnosed. This could lead to unsuitable treatment and in some cases can lead to the individual being wrongfully institutionalized.
The doctor will recommend the individual to try guided self-help course to see if the client can maintain their anxiety (NHS 2018). This guided self-help innovation is Cognitive behavioural based (NHS 2018). It could be presented as a workbook/computer course or as a group course. The individual would have to visit the group course weekly where they would try and work through the individual’s anxiety (NHS 2018). The GP could also offer the individual cognitive behavioural therapy which is called IAPT (NHS 2018). Cognitive behavioural therapy will challenge the individual’s anxious thoughts. This form of therapy will run for an hour a week over a period 3 to 4 months (NHS 2018).
IAPT is a service which offers psychological therapies for individuals who have been diagnosed with anxiety or depression (Thomas, 2018). The issue with IAPT is they heavily CBT based and does not use any other therapies/theories (Thomas, 2018). It is stated that this form of therapy over simplifies the client’s “issues” (Thomas, 2018). Also, IAPT’s tends to only offer six sessions. Six session isn’t sufficient enough to get build a trusting relationship with the client as well as working through their issue (Thomas, 2018). This could potentially be harmful towards the client as they may open up about a situation and they may not be able to work through them due to six sessions not being enough (Thomas, 2018).
The other format of treatment is medication. Here are some of the medications provided to individual who has been diagnosed with generalised anxiety disorder. They are put into to order based on their efficiency.
The pharmaceutical industry
The pharmaceutical industry is always developing new drugs (LaMattina 2012). To ensure they make money out of the new drugs, medical professionals prescribe them to their patients (LaMattina 2012). This seems to be a win win situation as both sides are benefiting from the situation (LaMattina 2012). The medical professionals are providing treatment to their patients and the pharmaceutical industry are making money (LaMattina 2012). However, there are important factors which the pharmaceutical industry does not want people to know;
- The pharmaceutical industry miscalculates the dangers of side effects (LaMattina 2012).
- They tend to control the information the doctors receive about the drugs (LaMattina 2012).
- Patients are likely to be prescribed drugs they do not need (LaMattina 2012).
- The drugs that are being produced tend to target the symptoms, not the main cause (LaMattina 2012).
Also, Pfizer inc is the biggest pharmaceutical company within America. They have created the diagnostic criteria for generalised anxiety disorder (GDA-7). By them creating the diagnostic criteria gives them more of an opportunity to make money and develop more drugs. This shows that the pharmaceutical industry is manipulating individuals’ vulnerable circumstances for their own financial gains.
General practitioner and psychiatrics could sometimes misdiagnose individuals (NHS 2018). For example, if an individual were to go to their GP about feeling anxious and over worrying. Their GP will ask them questions such as if they have experienced any physical or any psychological symptoms, how long have they been experiencing them, their worries/fears and some question about their personal life (NHS 2018). After this the doctor may send the individual for a blood test and then diagnose the individual based on the answers, they provided to the questions they asked. A problem with this is the doctor is basing their decision on the answers the client had given for the questions. Rather than observing the patient’s behaviour over a period of time and talking about their thoughts and feelings. This could also lead the individual entering a vicious cycle of being stigmatized and experiencing self-stigma.
Stigma occurs when there is a feeling of dissatisfaction within wider society (Mental Health Foundation 2018). A stigma could occur due to a specific situation, quality and individual (Mental Health Foundation 2018). This sense of dissatisfaction will be experienced by a large number within society (Mental Health Foundation 2018).
An individual who has been diagnosed with a mental “disorder” are especially challenged within society (PATRICK W CORRIGAN, 2018) As well as struggling with the diagnosis they have been given adding stigma and prejudice into the situation could be particularly hard for an individual (PATRICK W CORRIGAN, 2018) This could lead to individuals missing out on opportunities that could offer them a good quality of life (PATRICK W CORRIGAN, 2018). Stigma can be split into two groups; public stigma and self-stigma (PATRICK W CORRIGAN, 2018) Public stigma is the reaction society gives to an individual who has been diagnosed with a mental health “illness” and self-stigma is what the individual places on themselves (PATRICK W CORRIGAN, 2018). There are three factors which contribute to these forms of stigma; discrimination, prejudice and stereotypes (PATRICK W CORRIGAN, 2018).
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We all live in a society were stigma is common. Self-stigma is when the individual keeps their diagnoses a secret due to feeling guilty, ashamed and inferior compared to others (Goffman 1963). Individuals with mental health “illnesses” tend to adopt societies ideas and are likely to believe their value reduces due to their diagnosis (Goffman 1963). An individual who has been diagnosed and is experiencing stigma is most likely to have a low self esteem as well as having little or no confidence (Goffman 1963). Research has suggested that self-stigma models and prejudice are harmful to an individual perception of themselves (PATRICK W CORRIGAN, 2018). This could have an impact the individual’s recovery and could lead to social exclusion. Research also suggests that some individuals are angered by the judgement they experience (PATRICK W CORRIGAN, 2018). This has a positive impact because it empowers many individuals to gain a voice and speak against stigma and the way people who have been diagnosed with an “illness” have been treated (PATRICK W CORRIGAN, 2018).
Erving Goffman (1963) created a book of the theory stigma. He called it “Stigma: Notes on the Management of Spoiled Identity” (Goffman 1963). Within in the book he mentions how and individual shields their identity if they are seen as different within society (Goffman 1963). This could include their; behaviour or appearance. He stated that the main method an individual tries to avoid stigma is by disguising the “issue” from society (Goffman 1963). The main reason an individual may do this is because they feel as if being stigmatized is shameful (Goffman 1963). They also may feel disappointed within themselves because they could not meet the standards of society as well as feeling as society will be disgraced by them (Goffman 1963). So, they do whatever they can to not allow the “issue” to revealed to society. For example, if an individual were to meet someone for the first time and they have a mental health “illness” they may not mention their diagnoses that they have been given because they want to avoid feeling ashamed or being stigmatized (Goffman 1963).
Later Goffman extended this theory and created the theory of “Face Work” (Goffman 1963). He stated that there are three forms of symbolic imagery (Goffman 1963). These impacts how individuals act, think and how they respond to situations. He called the stigma symbols “dis-identifiers” (Goffman 1963).
He stated the way people interact with each other is like a theatrical performance (Goffman 1963). People base their judgement on each other based on their first impression (Goffman 1963). So, everyone ensures their first impressions are good. He categories the theatrical performance into two; the on stage and the back-stage performance (Goffman 1963).
He stated that while the individual is performing their onstage performance, they morph into the identity they think society and the other person expects them to be (Goffman 1963). It is most likely to occur when the individual is interacting with others (Goffman 1963). On the other hand, the back-stage performance isn’t considered as a performance, but this is done in private (Goffman 1963). The drops the identity they think the society wants them to be. This is when they reveal their true identity (Goffman 1963). Goffman believes that individuals do this to avoid embarrassment. Individuals they have to constantly change their identity due to society constantly changing as well as changing their identity due to the situation their in (Goffman 1963).
Thomas J. Scheff associated the labelling theory with mental “illnesses” in 1966. His main focus was to look at society’s perceptions and ideas about mental health “illnesses” (Scheff 1984). He believed that societal influences are what create mental health “illnesses” (Scheff 1984). He claimed that there are some behaviours which society classes as being deviant so for society to understand why people behave this way, they label the as being a mental health “illness” (Scheff 1984). After some time, expectations are placed on to the individual and the individual unconsciously adopts them behaviours that society has labelled them with (Scheff 1984). Scheff called this self-fulfilling prophecy. Some individuals who have been diagnosed like the idea of having a label as it allows them to put a name to their symptom (Scheff 1984).
Impact on family
Goffman did some work orientating around family members being stigmatized due to someone in their family having a diagnosis. Goffman stated this as a “courtesy or associative stigma, which is the process by which a person is stigmatized by virtue of association with another stigmatized individual” (Girma et al., 2014).Family members being stigmatized may not be due to the individual’s diagnosis there have been many studies showing that family members have experienced stigma (Girma et al., 2014). Family members may experience public stigma could be due to society thinking they failed to support the individual or help them find treatment (Girma et al., 2014). To avoid stigmatization the individual’s family members may try and hide their relative’s diagnosis away from society (Girma et al., 2014). This could be harmful towards the individual as this could cause a delay from them receiving treatment (Girma et al., 2014). Also, it could have an impact on the individual’s emotions as they would feel as a burden on their family (Girma et al., 2014). This could then lead the client to isolating themselves from their family and society (Girma et al., 2014).
The Mental Health Act (Section 136)
The mental health act is used when an individual gets sectioned into hospital against their will (Rethink 2018). The individual will only be detained under this act if there isn’t a safe place for the individual (Rethink 2018). They cannot be sectioned if they are at their own hoe or somebody else’s (Rethink 2018). While the individual is detained, they will be given a mental health assessment and will be kept under observation for 24 hours this can be extended an additional 12 hours (Rethink 2018). The individual has aright to know why they have been sectioned if they ask (Rethink 2018).
The Mental Capacity Act
The mental capacity act (2005) relates to anyone within care/treatment and support of people aged 16 who are incapable to make their own decisions (Scie, 2018). It protects individuals who lack capacity (Scie, 2018). It empowers individuals rather than them relying on professionals or family (Scie, 2018). It also allows individuals to plan ahead of time if they were ever to be in a situation where they lack capacity (Scie, 2018).
The Equality Act
The equality act protects individuals from discrimination (Citizensadvice, 2018). Discrimination could be done by; employers, transport services, schools/colleges, businesses/organisations, health care providers and public bodies (Citizensadvice, 2018). The equality act protects an individual’s; age, gender, race, disability, pregnancy/maternity, religion or beliefs, sex and sexual orientation (Citizensadvice, 2018). A mental health diagnosis would be considered a disability under this act (Citizensadvice, 2018).
How a counsellor would work with a client
Counsellors would be working alongside the BACP ethical framework. The BACP ethical framework is used by counsellors to support them to ensure they are providing ethical and safe practice to their clients (BACP 2018). It allows the counsellors to provide sufficient and beneficial services for their clients (BACP 2018).
The counsellor would first start off by doing an assessment based on the evidence the assessment has provided the counsellor would then choose a theory/theories they will use within the sessions. If the client wanted a goal orientated therapy the counsellor would use CBT. This type of therapy will be structured and will focus on what the client is currently experiencing (Beck 1967). It would be directive and the counsellor would help the client learn skills and find ways which will make the anxiety more bearable for the client to cope with on a daily basis (Beck 1967). CBT explores the way an individual sees a certain situation and reacts rather than looking at the situation on its own (Beck 1967).
The main idea of CBT theory is helping the client to change their unhelpful thinking and challenging it and replacing the negative thoughts with realistic ones (Beck 1967). For example, a client who has been diagnosed with GAD may panic when they are in crowded spaces the counsellor could suggest the client to write down the negative thoughts, recognise the cognitive distortions and then the counsellor would help the client come up with rational explanations (Beck Institute for Cognitive Behavior Therapy, 2016). The counsellor could also suggest techniques such as; practicing mindfulness once they feel as if their anxiety is becoming uncontrollable, using apps to manage their diagnosis for example headspace or journaling (Beck Institute for Cognitive Behavior Therapy, 2016).
Another form of therapy a counsellor could use is PCT. PCT focuses on the here and now (Rogers 1959). By a counsellor using PCT gives the client the space to talk about their feelings they are currently feeling. For example, a client who has been diagnosed with GAD is most likely to be stigmatised. Being stigmatised could lead to low self-esteem. The counsellor would use rogers they of conditions of worth. Conditions of worth are expectations that are put on an individual by society and people within their life (Rogers 1959). The individual will feel they need to meet these expectations to feel worthy. For example, the client may feel as if they aren’t worthy enough due to their anxiety. The counsellor could then integrate the idea of CBT and suggest the client to do positive affirmations to change their negative automatic thoughts.
The therapist could also use Rogers (1959) idea of personality development. Rogers stated our self-concept is split into three; self-worth, self-image and ideal self. Our self-worth is what we think about ourselves (Roger 1959). Self-image is how we see ourselves (Roger 1959). Finally, ideal self is the person we want to be (Roger 1959). The counsellor could incorporate this into the session if the client has low self-esteem. The counsellor could ask the client some questions based on these questions and if the client has a negative self-concept the counsellor could help the change their concept of themselves.
Power threat meaning framework
The power threat meaning framework can be used within mental health as well as other areas such as the justice system (Lucy Johnstone, 2018). The main purpose of the framework is to summaries and integrate evidence about the power roles within individuals lives (Lucy Johnstone, 2018). It also looks at how the power is misused and learned behaviours that protect us from threat (Lucy Johnstone, 2018). For example, when this framework is linked to mental health the threat is normally the “symptoms” (Lucy Johnstone, 2018). Also, the framework looks into how an individual makes sense of the difficulties they face and how society has an influence on them (Lucy Johnstone, 2018). Within the framework there are three main questions which are focused on;
- What has happened to you? (power operating your life)
- How did it affect you? (threats)
- What sense did you make of it? (meaning of the situation)
- What did you have to do to survive? (threat response)
(Lucy Johnstone, 2018)
There are two more additional questions that could be asked;
- What are your strengths? (power resources)
- What is your story? (threat response)
(Lucy Johnstone, 2018)
There are some words associated with mental health that can cause offence (Time To Change, 2018). So, it is important counsellors are mindful of their language (Time To Change, 2018). Here are some words a counsellor should never use; psycho, schizo, lunatic, nutter, mentally ill and a sufferer/suffering from (Time To Change, 2018). Counsellors should try are use phrases such as “some on who has been diagnosed with” or “a person who has experienced symptoms of” (Time To Change, 2018). It is also important the counsellor doesn’t look at the client through their diagnosis or use them labels because the client could feel they are disregarding their experience and seeing them through their diagnosis (Time To Change, 2018).
Overall, it is highly important for a counsellor to be aware of the client’s experience. They should also be conscious of the stigma around mental health diagnoses. As well they should perceive the client through their experiences not through their diagnosis or symptoms.
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