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What causes people to die changes over time, but the group at greatest risk of dying from these afflictions, those low in socioeconomic status stays the same

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Paradox

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*co-founded Partners and Health in the poorest country *Wrote books that demonstrated the linkages between poverty and illness

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Paul Framer

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social power, political power, and prestige for a variety of reasons

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Doctors have a great amount of

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*They offer a universally valued product—health and longevity. **Since they offer someone every wants/needs they earn power and prestige **Waiting in the doctor's office (bc you have too)

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Reasons doctors have a great amount of power?

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due to the extensive education and training and the strict regulation of the profession *Currently, there are approximately 190 doctors per 100,000 individuals in the United States, compared to 246 lawyers, 402 accountants, and 536 college teachers. It can take 20 years or more plus a medical residency before a person can become a practicing physician.

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Why are there limited number of doctors?

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which allows doctors to maintain the exclusiveness of their professional and contributes to their privileged position

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How does the number of medical schools and graduates being strictly regulated do?

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*standing among their peers

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Doctors are very concerned with their

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very personal information and expect individualized treatment

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What do people trust doctors with?

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Doctors have not always been highly valued in society, but since the eighteenth century their power and prestige has steadily grown as they got much better at treating illness and injury (through advances in technology and knowledge). They banded together as professionals and developed licensing systems. In addition, doctors assumed a dominant role in their relationship with hospitals because they were the ones bringing in new patients. There is now more external regulation of the medical profession, and there has been a significant increase in the use of alternative medicine such as acupuncture, chiropractics, and herbal medicine.

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How has doctors value in society changed over time?

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specific props and scripts

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What do doctors use to assert their power?

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Intimate but objective nature of their conversations with patients

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Profession norm for doctors

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is a professional who violates this "other doctor's approval" by seeking to make a client happy

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"quack"

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found that patients consider interpersonal confidence the most important factor in rating their doctors ("Bedside manner" or trust is what matter most)

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David Mechanic and Sharon Meyer

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other benefits and privileges (set their own rates)

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The power and prestige doctors has translated into?

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causes the problem of doctors created excess demand for their services

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"supplier-induced demand"

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gives doctors self-regulation bc they have monopoly over the policing of their own, and are reluctant to take away a doctor's license

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AMA

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the process by which problems or issues not traditionally seen as medical come to be framed as such (ex: alcoholism) *An example: viewing an old person's forgetfulness as a health problem rather than as a natural part of aging that one has to cope with

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Medicalization

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judicial system

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Doctors are key players in the?

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bc in earlier times doctors were rather incompetent and eventually gain prestife through more effective advances in technology and knowledge

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Why haven't doctors not always been as socially prestigious and powerful ?

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guided by the notion that the "poison is the cure" and was a widely follow medical practice in the 19th century

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Homeopathy

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more economic clout b4 medicine was consider philanthropic with no legal recourse (made the profession more exclusive and gave doctors more economic power)

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What did licensing give doctors?

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*Market forces had infiltrated medicine *Rise of external regulation (AMA is no longer sole arbiter) *Rise of technology (nurse practitioners) *Internet ~ can do your own medical research online **Patients can arm themselves with a great deal of information prior to meeting with a physician and therefore can speak more knowledgeably and confidently about their condition and possible treatments

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Decline of doctors authority in 1990:

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no "drive-through deliveries"

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Clinton's (health policy)

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require ERs to treat/at least stabilize your condition (Clinton)

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EMTALA

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nontraditional medicine

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Heterodoxy

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concept describing the social rights and obligation of a sick individual

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Sick role

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*He developed the concept of the sick role, which assigns a sick person rights and obligations. *However, this conception is very individualistic and does not take into account how social conditions can affect a person's health.

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Talcott Parsons

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*not required to perform normal social roles (are expected to try to get well) *not held accountable for their own condition (to seek competent doctors to help)

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People occupying the sick role are:

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a social construct: what it means to be sick (or healthy) has changed throughout history and differs from one place to another.

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illness

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universal health care

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Unlike many other industrialized nations, the United States does not offer?

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*fee-for-service (paying co-pay) *health maintenance organizations (HMOs) *Medicare *Medicaid

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The four main types of health-care coverage in the United States are:

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(paying co-pay) *risk adjustment - insurance companies can adjust your co-pay bc of certain factors *main problem is doctors incentive to overtreat (which drives up costs)

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Fee-for-service

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*developed in an attempt to hold down cost by paying doctors a salary based on the number of patients they take on *gives doctors more of an incentive to keep the patient healthy *HOWEVER this system gives doctors the incentive to undertreat (since paid per patient no fee per treatment)

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Health maintenance organizations (HMOs)

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*a joint federal and state program that helps cover medical costs for poor people with limited resources *covers most ppl over 65 and ppl with disabilities

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Medicare

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program for certain people and families with low incomes and resources

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Medicaid

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to provide more money and state-level assistance for children's health care

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SCHIP

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*outcomes like mortality rates, life expectancy, and quality **Important factors are: nutrition, clean water, lifestyle choices, and social positions

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The truth is that health care and health-care systems is not very important in predicting :

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*focused on one occupation sector, civil servants, and controlled for the differences between men in different occupation and examined the differences among men of different social classes in similar occupations *evident that social forces affect our bodies, our morbidity, and our general risk of mortality *Arguments against study say that is does not adequately address the possibility that underlying personality differences and skills set led to both occupational and health differences or that health directly determined the rand to which ppl rose by virtue of its effect on productivity

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The Whitehall Study

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illness in a general sense

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Morbidity

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death

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Mortality

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study of the height of Dutch people show that social factors such as where you live, what you do for a living, and how much money you earn, particularly in relation to other members of the society in which you live, have a greater influence on your health than health care and health-care systems. (also whitehall study)

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John Komlos's

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*The detection of diseases, genetic anomalies in fetuses which raise difficult ethical questions and have major social implications. *Multiple births (often due to assisted reproductive technology) and premature births, which present further medical and ethical dilemmas.

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Technological advances in medicine have allowed for:

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adulthood due to high mortality rates for males

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Although sex ratios are 105 to 100 girls born this number flip flops by ?

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*with whites having the best outcomes overall. The starkest differences can be found between whites and blacks. *This is true even of the lifespan in general, which is typically longer for whites than blacks or other minorities.

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There are numerous health discrepancies between races in the United States which are?

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(under Clinton) made the reduction of health disparities by race one of his primary goals

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David Satcher

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health *While some of the discrepancy is due to differences in socioeconomic status, there are still significant differences between whites and blacks with the same income and education level

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Racism plays a role in people's overall

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drew on the symbolism of John Henry to suggest a link between historical and cultural factors that lead to high rates hypertension among blacks

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Sherman James

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*Selection theory *The drift explanation *Social determinants theory

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Three main theories that attempt to explain why people with higher socioeconomic status have better health:

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the connection between low income and poorer health - has mediating factors. For instance, other factors, like genetics, might affect both socioeconomic status and health.

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Selection theory

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states that there is a connection between income and health. If you have poor health, you might be less likely to find gainful employment. (good health is key)

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Drift explanation

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states that social status can determine a person's health.

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Social determinants theory

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*Psychosocial interpretation *Materialistic interpretation *Fundamental causes interpretation

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Factors that can cause social determinants?

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focuses on individual's social class status relative to that of those around them ( feeling inadequacy =stress on body)

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Psychosocial interpretation

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asserts that the differential access to a healthy life (including monetary, psychological, and environmental factors)

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Materialistic interpretation

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examines how social factors shape illness and health to understand link (distribution on resources) (women learning about BPA and replacing all bottles in her house)

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Fundamental causes interpretation

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live longer, but it is not clear whether marriage actually benefits a person's health or if healthier people tend to get married.

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Married people tend to?

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types of illnesses each sex is more susceptible to as well as to how willing each sex is to seek medical care *Females born in 2005 are expected to live for an average age of 80.1 years, while males are expected to live 74.8 years. *Average life expectancy for white women is 80.7 compared to 70.2 for black men

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Women living longer than men can be attributed to?

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*higher child mortality rates, due to greater demands on parents' financial and emotional resources. **Spacing of children plays a role **First born children are more likely to die young/ also only children

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Large families and children born close together are both associated with

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*provides a standard categorization of mental disorders and their definitions. *Changes in this manual, particularly from its second to third editions, have strongly influenced how mental illness is understood and treated. **Beginning with the manual's third edition, there has been a much greater emphasis on *diagnostic psychiatry *dynamic psychiatry

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Diagnostic and Statistical Manual (DSM)

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focuses on identifying the internal conflicts that produce a mental illness

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Dynamic psychiatry

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focuses on identifying symptoms of a specific underlying diseases and treating them

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Diagnostic psychiatry

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* asked the question if society is really more depressed than before *argue that the context is widely ignore

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Horwitz and Wakefield

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plays and teaches classical piano, something she couldn't do until antidepressant medications helped her out of depression. While she agrees the medicines should be closely monitored, especially with new patients, she credits her treatment for allowing her to live a full life.

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Kathryn Orrick

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significantly increasing

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The use of pharmaceuticals to treat mental illness has been?

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*devaluation of the benefits of talk therapy *overprescribing or mis-prescribing of pharmaceuticals *stigma attached to taking medication for mental illness *Increasing power of pharmaceutical companies.

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Some negative aspects about the rise of the use of pharmaceuticals to treat mental illnesses?

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pharmaceutical companies *Many psychiatrists consider the use of pharmaceuticals as simply one tool in the toolbox of ways to treat an individual, but as the medical profession becomes more like a consumer model and as pharmaceutical companies market their products directly to "consumers" through advertisements, it becomes more difficult for the medical professional to convince patients that using medicines alone might not be in their best interest.

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Who has benefited from the growth of the use of pharmaceuticals?

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the disparities that exist between the United States and developing countries. **Many developing countries are still struggling to provide their citizens with safe drinking water, sanitation, and basic health care

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Health disparities between groups within the United States are dwarfed by ?

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*Malaria, which is far from being eradicated in many countries, has been identified as a major obstacle to economic development. (WHO helped out) *Antibiotics, one of the greatest medical achievements, are becoming less effective as antibiotic-resistant strains of diseases emerge and diseases once thought to have been "conquered" reappear. *Even though a wide range of drugs have been developed to combat HIV and AIDS, the disease continues to ravage many developing countries because people (and governments) cannot afford to buy the drugs and, even if they can, their lack of access to proper nutrition and clean water can limit the drugs' effectiveness.

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Examples of disparities between countries?

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*compares economic development in India and China. *States no malaria-endemic region of the world has ever developed economically

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Jeffrey Sachs

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*taxes us to stay health **An example would be: Sugar at 1 cent an ounce or 12-pack sodas (limit our freedom?) **Real example: tobacco tax (actually seems to cause less smoking)

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"Sin Taxes"

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power and prestige of doctors in our society

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Being made to wait anywhere from a few minutes to over an hour in order to see a doctor is evidence of the ?

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prescribe medications, set their pay rates, regulate themselves

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Traditionally, doctors have had the power to ?

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*Pharmaceutical companies put pressure on the medical profession to try drug therapies with their patients. *As mental illness has increasingly been linked with biomedical causes, drug therapies are often seen as the best treatment option. *Insurance companies are often more willing to reimburse patients for drug therapies than for many sessions of talk therapy with a counselor or psychologist.

answer

1. Why has there been a rise in the use of pharmaceutical treatments for mental illness?

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