Evaluate psychological research relevant to the study of abnormal behaviour

Evaluate psychological research relevant to the study of abnormal behaviour. (22)

Evaluate (22) – An appraisal by weighing up the strengths and limitations.

Abnormal Studies

Rosenhan – On being sane in insane places (I)
[A]	Challenge the reliability and validity of diagnosis. Investigate the effects of labeling.
[P]	Eight participants, 5 male and 3 female, attempted to gain admittance in the hospital’s psychiatric ward. Participants phoned up the hospital for a diagnosis appointment. They all used a fake name and job (to protect their future health and employment record <- ethical considerations). All the participants claimed that they were hearing voices. These are existential symptoms which arise from concerns about how meaningless your life is. They were chosen because there were no mention of existential psychosis in the literature. After admitted into the psychiatric ward, they stopped showing the pseudo-symptoms and acted like they would ordinarily. Participants started making notes about their life and the way the were treated in the ward. Initially, they had to write in secret because they are scared wardens might find out. Afterwards, they realized no one cared so they did it more publicly. Participants asked the staffs for a favor that tested the behaviour of staff towards patients, which took the following form: ‘Pardon me, Mr/Mrs/Dr X, could you tell me when I will be presented at the staff meeting?’. (or ‘…when am I likely to be discharged?’) Similar procedure was carried out with Students at Stanford University with students asking university staff a simple question. Results were used to compare.
[F]	All pseudo-patients disliked the environment and wanted to be discharged immediately. All participants were “diagnosed” with schizophrenia. No staff suspected their sanity. Patients in the ward, however, did suspect the sanity of some of them, and reacted vigorously. For example: ‘You’re not crazy. You’re a journalist, or a professor. You’re checking up on the hospital’. Patients were deprived of almost all human rights e.g. privacy Medical records were not kept confidential Hygiene was poor Wardens would be brutal to patients when no other warden was around Indicates that patients had no credibility, but wardens do. Time spent with nurses, psychiatrist etc. averaged under 7 minutes per day.
[C]	There is an enormous overlap in the behaviours of the sane and the insane. We all feel depressed sometimes, have moods, become angry and so forth. But in the context of a psychiatric hospital, these everyday human experiences and behaviours were interpreted as pathological. Regarding the favor asked, most pseudo patients were ignored. where as all questions were addressed in the Stanford University experiment. Experience of hospitalisation for the pseudo patients was one of depersonalisation and powerlessness.
[E]	Field experiment/covert observation, high ecological validity. Can argue that experiment is low in ecological validity, psychiatrist don’t usually diagnose “pseudo-patients”. It is expected that the person will have some sort of disorder if they seek diagnosis. Psychiatrists would normally play safe in their diagnosis. Because there is always an outcry when a patient is let out of psychiatric care and gets into trouble. Always a higher likelihood of diagnosing a normal person sick than a sick person normal. DSM-II was in used then, an updated version of the DSM (DSM-IV) used now has more sophisticated descriptions for diagnosis. Showed that patients suffering from psychological disorders experienced. Labeling and stigmatization Depersonalisation Discrimination Controversial study. Deception was involved, unethical.

Rosenhan – On being sane in insane places (II)
[A]	Follow up study for Rosenhan – On being sane in insane places (I)
[P]	Falsely inform psychiatric institute that were aware of the first study that during the next three months one or more pseudo patients would attempt to be admitted into their hospital. Staff members were asked to rate on a 10-point scale each new patient as to the likelihood of them being a pseudo patient. No pseudo patients were sent.
[F]	193 patients were judged 41 were confidently identified as a pseudo patient by at least one member of staff 23 were suspected as pseudo patients by a psychiatrist 19 were suspected by a psychiatrist and a member of staff
[C]	Rosenhan claims that the study demonstrates that psychiatrists cannot reliably tell the difference between people who are sane and those who are insane. The main experiment (I) illustrated a failure to detect sanity, and the secondary study (II) demonstrated a failure to detect insanity. Everything a patient does is interpreted in accordance with the diagnostic label once it has been applied. The result of labeling/stigmatization Should focus on individual’s specific problems regarding behaviour rather than their sanity.
[E]	Deception was involved, unethical. Research was done at the cost of misdiagnosis of patients with actual mental disorders.

Abnormal Theories

Criteria for abnormality

Mental Health Criteria – Jahoda
Condition	Explanation
Positive self attitude	Having a positive self concept
Self actualisation	Striving to fulfill potential
Personal autonomy	Being fairly self-reliant
Accurate perception of reality	Having a realistic view of ourselves/the world
Adapting to the environment	Being flexible and adaptive
Resistance to stress	Ability to tolerate anxiety

Seven Criteria of Abnormality – Seligman & Rosenhan
Condition	Explanation
Suffering	Distress or discomfort.
Maladaptiveness	Engage in behaviour that made life more difficult.
Irrationality	Incomprehensible, cannot communicate in a reasonable manner.
Unpredictability	Act in ways that are unpredictable.
Unconventionality	Experiencing things that are different.
Violation of moral and ideal standards	Breaking ethical and moral standards.
Observer discomfort	Acting in ways that makes other feel discomfort.

Evaluation and criticism:

They are value judgements about mental health, i.e. they reflect the ideals and values of the person who constructed the list.
A psychopath, for example, often has a very positive attitude to self, but his amoral behaviour is likely to be seen very negatively by others.
Ambiguity and subjectivity in defining terms e.g. reality and positivity.
There are people who are normal that does not fulfill the characteristics and people that are abnormal that fulfill the characteristics.
Influenced by cultural attitudes.
Too idealistic, only a few individuals can achieve the idealistic self.
Too difficult to measure, too vague to diagnosis.

Classification/Diagnosis systems

Classification systems are suppose to be objective.
Traditional medical model in psychiatry is now assumed to be reductionist.
Most psychiatrists use a biopsychosocial approach in diagnosis and treatment.
Diagnose based on symptoms.
Affective (mood) symptoms
Behavioural symptoms
Cognitive (thought process) symptoms
Somatic (physical) symptoms
Based heavily upon abnormal experiences and belief reported by patients.
Agreed by a team of professionals.
Explains why Classification/Diagnosis systems are often updated and revised.

Strengths of classification systems

Statistical diagnosis
Quantifiable
Ability to identify disorders based on symptoms
Therefore suitable treatment can be applied

Weakness of classification systems

Ethical consideration is the main weakness of Classification systems
The effects of labeling
Leads to stigmatisation
Prejudice and discrimination
Self labeling can lead to Self-fulfilling prophecy
Person diagnosed with disorder act according to the label

DSM – Diagnostics and Statistical Manual of Mental Disorders
A handbook used by psychiatrists in the US to identify and classify symptoms of psychiatric disorders.
Standardised system in diagnosis based upon

patient’s clinical and medical conditions
psychosocial stressors
the extent that a person’s mental state interfere with their daily life

Five axis of the DSM
Axis 1: Clinical Syndromes
Axis 2: Developmental and Personality Disorders Axis 3: Medical Conditions
Axis 4: Psychosocial stressors
Axis 5: Global assessment of functioning

Ethical concerns regarding the DSM

Better to regard those suffering from mental disorders as “sick” rather than “morally defective”.
Removes responsibility from the patient.
Does not completely prevent patients from being labeled.