Abnormal Psychology
List of studies for Abnormal Psychology with Learning Outcomes
5.1 Examine the concepts of normality and abnormality
5.2 Discuss validity and reliability of diagnosis
5.3 Discuss cultural and ethical considerations in diagnosis
Evaluate psychological research (that is, theories and/or studies) relevant to the study of abnormal behaviour
5.4 Describe symptoms and prevalence of two disorders
5.5 Analyse etiologies of one disorder
5.6 Discuss cultural and gender variation in prevalence of disorders
5.7 Examine biomedical, individual and group approaches to treatment
5.8 Evaluate the use of biomedical, individual and group approaches to treatment
5.9 Discuss the use of eclectic approaches to treatment
5.10 Discuss the relationship between etiology and therapeutic approach in relation to one disorder.
5.1 Examine the concepts of normality and abnormality
5.2 Discuss validity and reliability of diagnosis
5.3 Discuss cultural and ethical considerations in diagnosis
Evaluate psychological research (that is, theories and/or studies) relevant to the study of abnormal behaviour
5.4 Describe symptoms and prevalence of two disorders
5.5 Analyse etiologies of one disorder
5.6 Discuss cultural and gender variation in prevalence of disorders
5.7 Examine biomedical, individual and group approaches to treatment
5.8 Evaluate the use of biomedical, individual and group approaches to treatment
5.9 Discuss the use of eclectic approaches to treatment
5.10 Discuss the relationship between etiology and therapeutic approach in relation to one disorder.
When writing these essays, know that there are three criteria:
1 - Knowledge and Comprehension (/9)
the answer demonstrates a detailed, accurate knowledge and understanding relevant to the question, and uses relevant psychological research effectively in support of the response.
2 - Evidence of Critical Thinking (/9)
the answer integrates relevant and explicit evidence of critical thinking in response to the question - i.e. application, analysis, synthesis, evaluation.
3 - Organisation (/4)
the answer is well organised, well developed and focused on the question.
The Essay Format:
Introduction: introduce the essay question and your argument. This should be short and focused.
Main body: five or six paragraphs. In this section make sure you have a clear flow of argument and always link back to the premise of the question after you have argued a point. Remember to critically analyse your points too.
Conclusion: relate directly to the essay question and make logical conclusions about what you have argued.
Studies explained for Abnormal Psychology
Section one - concepts and diagnosis
Discuss the concepts of normality and abnormality
Defining normality - Jahoda (1958)
Opposing theory - Taylor and Brown (1988)
Defining abnormality - Szasz (1962)
Another theory - Read et al. (2004)
Discuss validity and reliability of diagnosis
Diagnosis - diagnosis within abnormal psychology means identifying and classifying abnormal behaviour on the basis of symptoms, the patients' self-reports, observations, clinical tests or other factors such as information form relatives. Clinicians use psychological assessment and diagnostic manuals to make diagnosis.
Diagnosis manual (DSM) Diagnostic and Statistical Manual of Mental Disorder (DSM) defines a mental disorder as a clinically significant syndrome associated with distress, a loss of functioning, an increased risk of death/pain, or an important loss of freedom. The DSM-IV is in it's fourth revised version. It is developed by the American Psychiatric Association. The manual lists what it terms "mental disorders". For each of the 300 disorders there is a list of symptoms that the clinician could look for in diagnosing a patient. It does not mention the cause of the disorder but describes the symptoms.
The International Classification of Diseases (ICD) is more commonly used internationally than the DSM and it covers a wide range of diseases and conditions for the sake of classification rather than diagnosis. There is a chapter in the ICD that categorises mental disorders that is very similar to the DSM and the ICD has fewer categories than the DSM because each category tends to be slightly broader. The biggest difference between the two systems is that the ICD is intended primarily as a classification system but includes details of what symptoms are required for diagnosis.
Validity - validity of diagnosis refers to receiving the correct diagnosis. This should result in the correct treatment and prognosis. Validity presupposes reliability of diagnosis. It is much more difficult to provide a correct diagnosis and give a prognosis for a psychological disorder than for a physical disorder because it is not possible to observe objective signs of the disorder in the same way.
Mitchel et al. (2009) - Meta-analysis of validity of diagnosis of depression.
The study used data from 41 clinical trials that had used semi-structured interviews to assess depression. The general practitioners had 80% reliability in identifying healthy individuals and 50% reliability in diagnosis of depression. Many GP's had problems making diagnosis for depression. Mitchel et al. argued that GP\s should see patients at least twice before making a diagnosis since accuracy could be improved after several examinations. The issue here is that Mitchel et al. may have misinterpreted the data because it is not certain that each study that they looked at used the same definitions.
Reliability - reliability of diagnosis means that clinicians should be able to reach the same correct diagnosis consistently if they use the same diagnostic procedure. This is called inter-judge reliability. Reliability can be improved if clinicians use standardised clinical interview schedules, which define and specify sets of symptoms to look for. The individual psychiatrist must still make a subjective interpretation of the severity of the patient's symptoms. The manuals have increased in reliability but there are still flaws.
Brown et al. (2001) - In 2001, Brown et al. studied anxiety and mood disorders in 362 outpatients in Boston, to test reliability of the DSM-IV and patients underwent two independent interviews using anxiety disorder interview schedules for DSM-IV, known as the life-time version. Brown found good-to-excellent reliability for most of the DSM-IV categories (most of the disagreements tended not be on what the symptoms were, but simply if there were enough of them). However, they found some boundary problems with certain disorders, which made it hard to diagnose patients with disorders if they were at boundary level. Overall, the study highlights some problems with the DSM but generally proves it to be a reliable tool.
Reliability is a necessary prerequisite for validity.
Rosenhahn (1973) - "on being sane in insane places"
Aim: The aim of this study was to test the hypothesis that psychiatrists cannot reliably tell the difference between people who are sane and those who are insane.
Procedure: They attempted to gain admission to psychiatric clinics across the US. They told the hospital staff that they had heard a voice saying, "One, two, three, thud.” This was not true, but it was the only sort of deception used in interactions with the hospital staff. The pseudo-patients answered all other questions truthfully. They were all admitted to hospital for observation, and they stayed there for an average of 19 days before being released. Once inside the hospital, they all acted normally, but seven of the pseudo-patients were diagnosed with schizophrenia.
Conclusion:
· The hospital staff made Type 2 errors as they mistook sane people for being insane and even the other patients could tell they were “normal”
· Psychiatric diagnoses are “sticky labels” as once you have been labelled a mental illness, it is hard to persuade others that you are sane and everything you do contributes to an example of madness. Those that walked around the corridors out of boredom were described as suffering from “anxiety”
· Rosenhahn also claimed that hospitals made the participants feel powerless and depersonalised all the participants. Staff were reported to swear at patients and punish them for small things.
· Can’t define insanity and sanity.
· Instead of labelling someone, we should focus on the individual and their behaviour
The main experiment illustrated a failure to detect sanity, and the secondary study demonstrated a failure to detect insanity.
Evaluation: The participant observation meant that the pseudo patients could experience the ward from the patients’ perspective while also maintaining some degree of objectivity. The study was a type of field experiment and was thus fairly ecologically valid whilst still managing to control many variables such as the pseudo patients’ behaviour. Rosenhahn used a range of hospitals. They were in different States, on both coasts, both old/shabby and new, research-orientated and not, well-staffed and poorly staffed, one private, federal or university funded. This allows the results to be generalised.
Rosenhahn did note that the experiences of the pseudo-patients could have differed from that of real patients who did not have the comfort of knowing that the diagnosis was false. Perhaps Rosenhahn was being too hard on psychiatric hospitals, especially when it is important for them to play safe in their diagnosis of abnormality because there is always an outcry when a patient is let out of psychiatric care and gets into trouble. If you were to go to the doctors complaining of stomach aches how would you expect to be treated? Doctors and psychiatrists are more likely to make a type two error (that is, more likely to call a healthy person sick) than a type one error (that is, diagnosing a sick person as healthy)
Ethical Considerations: The hospital staff were deceived - this is, of course, unethical. Although Rosenhahn did not conceal the names of hospitals or staff and attempted to eliminate any clues which might lead to their identification.Gender and Cultural Considerations:
- There was almost a 50/50 ratio of men to women – making it easier to conclude results.
- The cultural considerations are limited as they were given quite strict instructions, which cultural values would not have changed the results.
So What? How did this study contribute to understanding of abnormal behaviour?
This study has helped show that mental illnesses are hard to define and diagnose. It also highlights that we, as humans, like to label things as we categorise behaviours into few headings when mental disorders are actually quite unique and personal to the individual.
“Normal behaviours were overlooked entirely or were profoundly misinterpreted. Minor disagreements became deep-seated indicators of emotional instability. Boredom was interpreted as nervousness or anxiety.”
This has helped progress the understanding that diagnosis is difficult.
Alternative Explanations:
- It is perhaps, in some cases, a good thing that hospitals are overly cautious and doctors usually are more likely to make a type two error than type one.
Discuss cultural and ethical considerations in diagnosis
Abnormal Psychology focuses on studying people with unusual behaviour, involving disorders like depression. However, diagnosis is not always precise as different cultures have different ways of determining whether someone is abnormal. Culture has the ability to influence the way in which someone may diagnose a disease, which results in a conflict of universal misdiagnosis. When diagnosing a patient there are also a number of ethical considerations that must be thought of, as there are many studies, which are tested on people with mental disorders, and there could be the potential for harm, elements of labelling and depersonalisation caused to participants. In order to discuss these considerations, studies testing diagnosis are looked at and evaluated.
Culture has the ability to influence the way in which people diagnose disorders. This is caused by the ambiguity in the term “abnormal” and how this is defined differently in diverse cultures. This is often an issue as it can cause conflict when considering the validity and reliability of diagnosis.
The Western approach believes that illnesses are rooted solely in Biology but this implies that culture is not a factor when considering abnormality. This shows how abnormality is subject to change due to which culture you are from. The Diagnostic and Statistical Manual of Mental Disorders (DSM) is published by the American Psychiatric Association and provides standard criteria for diagnosing disorders. However it is often criticised because of its lack of cultural consideration. An example of a cultural-bound syndrome is the case of Shenjing Shuairou, China. The disorder has symptoms of fatigue and memory loss, which is found in the Chinese Classification of Mental Disorders (CCMD) but not the DSM. This shows that there are many cultures that diagnose disorders in different ways.
It is also known that in the Asian culture, depression symptoms are overlooked due to the fact that diagnosis for this disorder is vague. Rack (1982) explained that in Asia doctors are usually only consulted when the patient is in physical pain, rather than emotional pain, so in their culture it is common for depression to be overlooked. Psychologists explain this through stating that there are significant differences in the way that cultures diagnose disorders. Asians, in particular, were found to use their family for support. Marsella (2003) also describes the difficulty with diagnosing depression as some cultures focus diagnosing based on the emotional elements, whereas others pinpoint and aid the physical symptoms of the patient. This explains why there is so much controversy on disorders and why there are possible variations in symptoms.
Culture (or racial) bias is also found to be a factor when diagnosing patients, as there may be some prejudice and discrimination when looking for symptoms based on stereotypes. Jenkins-hall and Sacco (1991) used European-American therapists and asked them to watch a video, which included interviews of female patients that may have depression. There were four conditions; an African American who was not depressed, a European who was not depressed and an African American and European who were depressed. The researchers discovered that the therapists rated the two females who were not depressed the same but were more likely to diagnose the African American woman depressed. She was described in a negative way and the therapists saw them to be less socially confident. This shows that cultural bias can exist and therapists and psychologists must take this into consideration. For a more reliable diagnosis it is suggested that a variety of cultured therapists should evaluate a patient.
Diagnosis can also breech ethical codes and should be considered too, before diagnosing a patient, as this it can change the life of a patient if they are diagnosed falsely. One prevalent ethical issue is the labelling of people to a mental disorder, which is something that Rosenhahn (1973) investigated entitled ‘schizophrenia in remission’. The aim of the study was to see whether people who appeared at a psychiatric hospital would be diagnosed as insane after providing the correct symptoms. The pseudo patients all went to interviews and told the hospitals that they heard voices saying the words “thud”, “empty” and “thud”, which are all symptoms of schizophrenia. In this study the hospital staff labelled them into the schizophrenia category and the issue with labelling is that if patients are categorised into disorders, the label may be attached forever and prevent the patient from moving on (i.e. getting a new job) even when the disorder has been overcome. It can even affect the patients’ self-confidence and self esteem. It is also important to note that there is a lot of ambiguity in diagnosing disorders so the label may not even be correct. There are some criticisms of this study, however, so the blame does not fall on the hospital staff as they were only doing what they thought was right. It is perhaps, in some cases, a good thing that hospitals are overly cautious and doctors usually are more likely to make a type two error than type one. Also, the sample was too small so it is hard to generalise this study. Yet, labelling is a form of depersonalisation, and should be treated gently when diagnosing patients.
Rosenhahn (1973) also observed how, once you are labelled with a disorder, the hospital staff associated your “normal” behaviour with symptoms of the disorder, like when the pseudo patients were walking the corridors, this was seen as a sign of nervousness. He also suggested that if you are told that you have the potential of having a psychiatric disorder, and given a label, you will be treated as a mentally ill person and your behaviour will be attributed to the label in which you have – which could worsen the disorder. This includes the idea of confirmation bias and also links with the ethical consideration of the self-fulfilling prophecy as you might live up to the label that you have been given. Doherty et al. (1975) discovered that patients, who do not live up to this label, are able to recover much faster than those who showed the self-fulfilling prophecy. Therefore there is much to consider when labelling patients as it may make the patient worse and prevent them from a speedy recovery – especially if the diagnosis isn’t even correct.
One of the other ethical considerations that must be mentioned is discrimination when diagnosing, which has been mentioned previously as a cultural consideration but prejudice unfortunately exists among those who are labelled. Langer and Abelson (1974) explained that social option can use the self-fulfilling prophecy to discriminate against those who have suffered a mental disorder. In the study they showed viewers a clip of a younger man telling an old man about his job. There were two conditions, one that was told that the man was a job applicant and the other was told that the man had a mental disorder. After the clip the first condition described the man as being attractive and successful but the second condition described him as being frightened and dependent. This shows the effects that labelling someone as having a mental disorder can have on someone as if they are described as having a mental disorder, people will discriminate against them.
In conclusion, it is vital to think of all of these ethical and cultural considerations when carrying out research in this area of psychology, especially as the participants can be affected drastically. Once a diagnosis has been discussed and confirmed, it is hard to get rid of the label you have given and this may be life altering when the disorder has been overcome.
- Ethically, there remains the very grave issue of the risk of over-diagnosis and the unjust consequences flowing from stigmatisation needing to be balanced with the potential denial of treatment to those who need it, which can prevent a suicide or grievous bodily harm to a third party.
Evaluate psychological research (that is, theories and/or studies) relevant to the study of abnormal behaviour
Introduction
- What is abnormality?
- What are the key symptoms for abnormal behaviour?
- Why is defining abnormality so challenging?
- How has research enabled us to learn more about abnormal behaviour?
Idea 1 – Jahoda (1958)
- What is his main idea?
- What are the strengths and weaknesses of this idea?
- How has it contributed to psychological research?
Idea 2 – Diagnostic and Statistical Manual of Mental Health
- What is the main idea?
- What are the strengths and weaknesses of this idea?
- How has it been challenged by psychological research?
o Rosenhan - evaluate
o How does this show that more research is needed?
Conclusion
- Psychological research is limiting in abnormal behaviour if we are unable to define what it is – therefore much more research in this field is needed.
Section two - psychological disorders
Section one - concepts and diagnosis
Discuss the concepts of normality and abnormality
Defining normality - Jahoda (1958)
Opposing theory - Taylor and Brown (1988)
Defining abnormality - Szasz (1962)
Another theory - Read et al. (2004)
Discuss validity and reliability of diagnosis
Diagnosis - diagnosis within abnormal psychology means identifying and classifying abnormal behaviour on the basis of symptoms, the patients' self-reports, observations, clinical tests or other factors such as information form relatives. Clinicians use psychological assessment and diagnostic manuals to make diagnosis.
Diagnosis manual (DSM) Diagnostic and Statistical Manual of Mental Disorder (DSM) defines a mental disorder as a clinically significant syndrome associated with distress, a loss of functioning, an increased risk of death/pain, or an important loss of freedom. The DSM-IV is in it's fourth revised version. It is developed by the American Psychiatric Association. The manual lists what it terms "mental disorders". For each of the 300 disorders there is a list of symptoms that the clinician could look for in diagnosing a patient. It does not mention the cause of the disorder but describes the symptoms.
The International Classification of Diseases (ICD) is more commonly used internationally than the DSM and it covers a wide range of diseases and conditions for the sake of classification rather than diagnosis. There is a chapter in the ICD that categorises mental disorders that is very similar to the DSM and the ICD has fewer categories than the DSM because each category tends to be slightly broader. The biggest difference between the two systems is that the ICD is intended primarily as a classification system but includes details of what symptoms are required for diagnosis.
Validity - validity of diagnosis refers to receiving the correct diagnosis. This should result in the correct treatment and prognosis. Validity presupposes reliability of diagnosis. It is much more difficult to provide a correct diagnosis and give a prognosis for a psychological disorder than for a physical disorder because it is not possible to observe objective signs of the disorder in the same way.
Mitchel et al. (2009) - Meta-analysis of validity of diagnosis of depression.
The study used data from 41 clinical trials that had used semi-structured interviews to assess depression. The general practitioners had 80% reliability in identifying healthy individuals and 50% reliability in diagnosis of depression. Many GP's had problems making diagnosis for depression. Mitchel et al. argued that GP\s should see patients at least twice before making a diagnosis since accuracy could be improved after several examinations. The issue here is that Mitchel et al. may have misinterpreted the data because it is not certain that each study that they looked at used the same definitions.
Reliability - reliability of diagnosis means that clinicians should be able to reach the same correct diagnosis consistently if they use the same diagnostic procedure. This is called inter-judge reliability. Reliability can be improved if clinicians use standardised clinical interview schedules, which define and specify sets of symptoms to look for. The individual psychiatrist must still make a subjective interpretation of the severity of the patient's symptoms. The manuals have increased in reliability but there are still flaws.
Brown et al. (2001) - In 2001, Brown et al. studied anxiety and mood disorders in 362 outpatients in Boston, to test reliability of the DSM-IV and patients underwent two independent interviews using anxiety disorder interview schedules for DSM-IV, known as the life-time version. Brown found good-to-excellent reliability for most of the DSM-IV categories (most of the disagreements tended not be on what the symptoms were, but simply if there were enough of them). However, they found some boundary problems with certain disorders, which made it hard to diagnose patients with disorders if they were at boundary level. Overall, the study highlights some problems with the DSM but generally proves it to be a reliable tool.
Reliability is a necessary prerequisite for validity.
Rosenhahn (1973) - "on being sane in insane places"
Aim: The aim of this study was to test the hypothesis that psychiatrists cannot reliably tell the difference between people who are sane and those who are insane.
Procedure: They attempted to gain admission to psychiatric clinics across the US. They told the hospital staff that they had heard a voice saying, "One, two, three, thud.” This was not true, but it was the only sort of deception used in interactions with the hospital staff. The pseudo-patients answered all other questions truthfully. They were all admitted to hospital for observation, and they stayed there for an average of 19 days before being released. Once inside the hospital, they all acted normally, but seven of the pseudo-patients were diagnosed with schizophrenia.
Conclusion:
· The hospital staff made Type 2 errors as they mistook sane people for being insane and even the other patients could tell they were “normal”
· Psychiatric diagnoses are “sticky labels” as once you have been labelled a mental illness, it is hard to persuade others that you are sane and everything you do contributes to an example of madness. Those that walked around the corridors out of boredom were described as suffering from “anxiety”
· Rosenhahn also claimed that hospitals made the participants feel powerless and depersonalised all the participants. Staff were reported to swear at patients and punish them for small things.
· Can’t define insanity and sanity.
· Instead of labelling someone, we should focus on the individual and their behaviour
The main experiment illustrated a failure to detect sanity, and the secondary study demonstrated a failure to detect insanity.
Evaluation: The participant observation meant that the pseudo patients could experience the ward from the patients’ perspective while also maintaining some degree of objectivity. The study was a type of field experiment and was thus fairly ecologically valid whilst still managing to control many variables such as the pseudo patients’ behaviour. Rosenhahn used a range of hospitals. They were in different States, on both coasts, both old/shabby and new, research-orientated and not, well-staffed and poorly staffed, one private, federal or university funded. This allows the results to be generalised.
Rosenhahn did note that the experiences of the pseudo-patients could have differed from that of real patients who did not have the comfort of knowing that the diagnosis was false. Perhaps Rosenhahn was being too hard on psychiatric hospitals, especially when it is important for them to play safe in their diagnosis of abnormality because there is always an outcry when a patient is let out of psychiatric care and gets into trouble. If you were to go to the doctors complaining of stomach aches how would you expect to be treated? Doctors and psychiatrists are more likely to make a type two error (that is, more likely to call a healthy person sick) than a type one error (that is, diagnosing a sick person as healthy)
Ethical Considerations: The hospital staff were deceived - this is, of course, unethical. Although Rosenhahn did not conceal the names of hospitals or staff and attempted to eliminate any clues which might lead to their identification.Gender and Cultural Considerations:
- There was almost a 50/50 ratio of men to women – making it easier to conclude results.
- The cultural considerations are limited as they were given quite strict instructions, which cultural values would not have changed the results.
So What? How did this study contribute to understanding of abnormal behaviour?
This study has helped show that mental illnesses are hard to define and diagnose. It also highlights that we, as humans, like to label things as we categorise behaviours into few headings when mental disorders are actually quite unique and personal to the individual.
“Normal behaviours were overlooked entirely or were profoundly misinterpreted. Minor disagreements became deep-seated indicators of emotional instability. Boredom was interpreted as nervousness or anxiety.”
This has helped progress the understanding that diagnosis is difficult.
Alternative Explanations:
- It is perhaps, in some cases, a good thing that hospitals are overly cautious and doctors usually are more likely to make a type two error than type one.
Discuss cultural and ethical considerations in diagnosis
Abnormal Psychology focuses on studying people with unusual behaviour, involving disorders like depression. However, diagnosis is not always precise as different cultures have different ways of determining whether someone is abnormal. Culture has the ability to influence the way in which someone may diagnose a disease, which results in a conflict of universal misdiagnosis. When diagnosing a patient there are also a number of ethical considerations that must be thought of, as there are many studies, which are tested on people with mental disorders, and there could be the potential for harm, elements of labelling and depersonalisation caused to participants. In order to discuss these considerations, studies testing diagnosis are looked at and evaluated.
Culture has the ability to influence the way in which people diagnose disorders. This is caused by the ambiguity in the term “abnormal” and how this is defined differently in diverse cultures. This is often an issue as it can cause conflict when considering the validity and reliability of diagnosis.
The Western approach believes that illnesses are rooted solely in Biology but this implies that culture is not a factor when considering abnormality. This shows how abnormality is subject to change due to which culture you are from. The Diagnostic and Statistical Manual of Mental Disorders (DSM) is published by the American Psychiatric Association and provides standard criteria for diagnosing disorders. However it is often criticised because of its lack of cultural consideration. An example of a cultural-bound syndrome is the case of Shenjing Shuairou, China. The disorder has symptoms of fatigue and memory loss, which is found in the Chinese Classification of Mental Disorders (CCMD) but not the DSM. This shows that there are many cultures that diagnose disorders in different ways.
It is also known that in the Asian culture, depression symptoms are overlooked due to the fact that diagnosis for this disorder is vague. Rack (1982) explained that in Asia doctors are usually only consulted when the patient is in physical pain, rather than emotional pain, so in their culture it is common for depression to be overlooked. Psychologists explain this through stating that there are significant differences in the way that cultures diagnose disorders. Asians, in particular, were found to use their family for support. Marsella (2003) also describes the difficulty with diagnosing depression as some cultures focus diagnosing based on the emotional elements, whereas others pinpoint and aid the physical symptoms of the patient. This explains why there is so much controversy on disorders and why there are possible variations in symptoms.
Culture (or racial) bias is also found to be a factor when diagnosing patients, as there may be some prejudice and discrimination when looking for symptoms based on stereotypes. Jenkins-hall and Sacco (1991) used European-American therapists and asked them to watch a video, which included interviews of female patients that may have depression. There were four conditions; an African American who was not depressed, a European who was not depressed and an African American and European who were depressed. The researchers discovered that the therapists rated the two females who were not depressed the same but were more likely to diagnose the African American woman depressed. She was described in a negative way and the therapists saw them to be less socially confident. This shows that cultural bias can exist and therapists and psychologists must take this into consideration. For a more reliable diagnosis it is suggested that a variety of cultured therapists should evaluate a patient.
Diagnosis can also breech ethical codes and should be considered too, before diagnosing a patient, as this it can change the life of a patient if they are diagnosed falsely. One prevalent ethical issue is the labelling of people to a mental disorder, which is something that Rosenhahn (1973) investigated entitled ‘schizophrenia in remission’. The aim of the study was to see whether people who appeared at a psychiatric hospital would be diagnosed as insane after providing the correct symptoms. The pseudo patients all went to interviews and told the hospitals that they heard voices saying the words “thud”, “empty” and “thud”, which are all symptoms of schizophrenia. In this study the hospital staff labelled them into the schizophrenia category and the issue with labelling is that if patients are categorised into disorders, the label may be attached forever and prevent the patient from moving on (i.e. getting a new job) even when the disorder has been overcome. It can even affect the patients’ self-confidence and self esteem. It is also important to note that there is a lot of ambiguity in diagnosing disorders so the label may not even be correct. There are some criticisms of this study, however, so the blame does not fall on the hospital staff as they were only doing what they thought was right. It is perhaps, in some cases, a good thing that hospitals are overly cautious and doctors usually are more likely to make a type two error than type one. Also, the sample was too small so it is hard to generalise this study. Yet, labelling is a form of depersonalisation, and should be treated gently when diagnosing patients.
Rosenhahn (1973) also observed how, once you are labelled with a disorder, the hospital staff associated your “normal” behaviour with symptoms of the disorder, like when the pseudo patients were walking the corridors, this was seen as a sign of nervousness. He also suggested that if you are told that you have the potential of having a psychiatric disorder, and given a label, you will be treated as a mentally ill person and your behaviour will be attributed to the label in which you have – which could worsen the disorder. This includes the idea of confirmation bias and also links with the ethical consideration of the self-fulfilling prophecy as you might live up to the label that you have been given. Doherty et al. (1975) discovered that patients, who do not live up to this label, are able to recover much faster than those who showed the self-fulfilling prophecy. Therefore there is much to consider when labelling patients as it may make the patient worse and prevent them from a speedy recovery – especially if the diagnosis isn’t even correct.
One of the other ethical considerations that must be mentioned is discrimination when diagnosing, which has been mentioned previously as a cultural consideration but prejudice unfortunately exists among those who are labelled. Langer and Abelson (1974) explained that social option can use the self-fulfilling prophecy to discriminate against those who have suffered a mental disorder. In the study they showed viewers a clip of a younger man telling an old man about his job. There were two conditions, one that was told that the man was a job applicant and the other was told that the man had a mental disorder. After the clip the first condition described the man as being attractive and successful but the second condition described him as being frightened and dependent. This shows the effects that labelling someone as having a mental disorder can have on someone as if they are described as having a mental disorder, people will discriminate against them.
In conclusion, it is vital to think of all of these ethical and cultural considerations when carrying out research in this area of psychology, especially as the participants can be affected drastically. Once a diagnosis has been discussed and confirmed, it is hard to get rid of the label you have given and this may be life altering when the disorder has been overcome.
- Ethically, there remains the very grave issue of the risk of over-diagnosis and the unjust consequences flowing from stigmatisation needing to be balanced with the potential denial of treatment to those who need it, which can prevent a suicide or grievous bodily harm to a third party.
Evaluate psychological research (that is, theories and/or studies) relevant to the study of abnormal behaviour
Introduction
- What is abnormality?
- What are the key symptoms for abnormal behaviour?
- Why is defining abnormality so challenging?
- How has research enabled us to learn more about abnormal behaviour?
Idea 1 – Jahoda (1958)
- What is his main idea?
- What are the strengths and weaknesses of this idea?
- How has it contributed to psychological research?
Idea 2 – Diagnostic and Statistical Manual of Mental Health
- What is the main idea?
- What are the strengths and weaknesses of this idea?
- How has it been challenged by psychological research?
o Rosenhan - evaluate
o How does this show that more research is needed?
Conclusion
- Psychological research is limiting in abnormal behaviour if we are unable to define what it is – therefore much more research in this field is needed.
Section two - psychological disorders