To what extent do biological, cognitive and sociocultural factors influence abnormal behavior?
Evaluate psychological research (theories and/or studies) relevant to the study of abnormal behavior
Examine concepts of normality and abnormality (EQ) page 136/page 21
Knowledge (9)
Evidence - Rosenhan's Study - keep if brief - refer to Q and assumptions (link back)
Concepts of abnormality
Rosenhan's research
Butcher and Minochah research
Culture Bound Syndromes - normality varies from culture to culture --> should be understood and treated only within specific cultures (emic)
Horwitz - changing the definitions of abnormality
Anti-Psychiatry Movement- a way to cope with people the society cannot handle
Critical Thinking (9) IMPORTANT
Relate to emic and etics --> abnormality is etic, the way it is expressed and accepted is emic
Cultural Dimensions
Time/Place
Implications
CBS
Evidence - Rosenhan's Study - keep if brief - refer to Q and assumptions (link back)
Concepts of abnormality
- Statistical abnormality
- Deviation from social norms
- Mal-adaptiveness of behavior
- Suffering in distress
Rosenhan's research
Butcher and Minochah research
Culture Bound Syndromes - normality varies from culture to culture --> should be understood and treated only within specific cultures (emic)
Horwitz - changing the definitions of abnormality
Anti-Psychiatry Movement- a way to cope with people the society cannot handle
Critical Thinking (9) IMPORTANT
Relate to emic and etics --> abnormality is etic, the way it is expressed and accepted is emic
Cultural Dimensions
Time/Place
Implications
CBS
Discuss validity and reliability of diagnosis
Diagnosis: Identifying and classifying abnormal behavior on the basis of symptoms, the patients' self-reports, observations, clinical tests or other factors such as information from others.
Intro:
· Classification of mental disorders – identification of groups/patterns of behaviour/symptoms to form the disorder
· Allows psychiatrists, doctors and psychologists to easily identify groups of similar sufferers
· Allows a suitable treatment
· Allows researchers to investigate these groups of people to find out the aetiology
· Major systems of diagnosis – DSM and ICD
· DSM – Diagnostic and Statistical Manual of Mental Disorder
· Mental disorder – clinically significant syndrome associated with distress, loss of functioning, increase risk of death/pain, loss of freedom
· Describes disorders so that two clinicians referring to the system would agree with the diagnosis suggested
· Utilises multi-axial diagnosis, encourages a more holistic approach to understanding the person. DSM undergoes constant revisions and adapts to changes in thinking overtime
· ICD – International Classification of Diseases
· More commonly used internationally than the DSM – covers diseases and conditions for the sake of classification rather than diagnosis
· ICD is primarily a classification system but includes details of what symptoms are required for diagnosis
· Define validity and reliability
· Reliability: for a diagnostic system to be reliable it must consistently make the same diagnoses
· Validity: for it to be valid, the diagnoses must identify a real pattern of symptoms and apply appropriate treatment
BP1: Reliability – negative
· Inter-rater reliability – assesses the agreement with which different clinicians diagnose conditions in the same patients
· Nicholls et al showed neither ICD or DSM demonstrated good inter-rater reliability for the diagnosis of eating disorders in children
· 81 patients, aged 6-17 years with eating problems
· Classified using ICD and DSM and a system developed for kids by Great Ormond Street Hospital (GOS)
· DSM: Over 50% of kids were not diagnosed. Reliability = 64% agreement between raters, but was at this level because most raters agreed they couldn’t make a diagnosis
· ICD: 36% reliability
· GOS 88% reliability
· GOS – specifically designed for young kids.
· In terms of eating disorders and possibly other disorders the reliability of well-known diagnostic systems (ICD, DSM) may not be very reliable
+ shows that systems can’t be so reductionist/generalised – they need to incorporate children as well
- perhaps the GOS is too simple/easy to diagnose, because if the DSM and the ICD didn’t pick up on an eating disorder, the children may not actually have one
+ good range of ages – shows that the GOS can be applicable to many ages
+ large participant pool
BP2: Reliability – positive
· Pedersen et al gave 10 Danish GPs one day’s training to use the IDC criteria for diagnosing depression
· Over next 8 weeks they diagnosed 116 patients with a depressive episode. 71% reliability with a diagnosis of depression – good inter-rater reliability for ICD-10 in the case of depression
+ shows good inter-rater reliability using the ICD
- if anyone can diagnose someone then people may start self-diagnosing using the ICD criteria, leading to more problems
- What percentage shows a positive or negative inter-rater reliability?
+ Large participant pool, increases reliability of results
- Only Danish GPs, perhaps had more experience dealing with depressed patients – Olsen et al (2004) found major depression to be of a high prevalence in the Danish general population.
BP3: Validity – negative
· Rosenhan et al – being sane in insane places
· 5 men, 3 women went to 12 different hospitals across USA complaining of hearing voices, but presented life history and present state as normal
· Voices said single words like “empty” “thud” – unclear, unfamiliar, of the same sex. These were the only symptoms reported
· Seven were admitted with a diagnosis of schizophrenia
· Once in hospital, they stopped complaining of symptoms and tried to get out
· Average of 19 days for the pseudo-patients to be released
· Psychiatric classification of the time of discharge was “schizophrenia in remission” (may come back).
· Rosenhan also wanted to see if abnormal individuals could be classified as normal. He told staff that pseudo-patients would try to gain admittance. No pseudo-patients actually appeared, but 41 real patients were judged with great confidence to be pseudo-patients
· Of these real patients, 19 were suspected of being frauds by one psychiatrist and one member of staff
· Conclusion: not possible to distinguish between sane and insane in psychiatric hospitals.
· Lack of scientific evidence on which medical diagnoses can be made – shows lack of validity in diagnosis because were only diagnosed on one symptom.
- Unethical study: could have taken away needed attention to real patients at the hospital. Hospital staff were deceived
+ 12 hospitals in the USA – large number, range of hospitals. Generalisation allowed
+ Tried both ways – abnormal and normal
+ Participant observation – pseudo-patients could experience the ward from the patients’ perspective whilst still maintaining a degree of objectivity
+ Fairly ecologically valid – field experiment
- Psychiatric hospitals perhaps should play it safe with diagnosis of abnormality for the safety of society
- Doctors and psychiatrists are more likely to make a type two error (healthy person sick) than type one
- Psychiatric classification in use was DSM-II. Has been updated numerous times – now on DSM-IV.
- Arguing that mental illness is a social phenomenon – a consequence of labelling.
BP4: Validity – negative
· Caetano (1973)
· Videoed a male psychiatrist carrying out separate standardised interviews with a paid university student and with a hospitalised mental patient
· Two groups of people shown the video – 1) 77 psychology students 2) 36 psychiatrists
· Asked to diagnose the interviewees and rate their degree of mental illness. With each sample of viewers, there was random assignment to two different groups, each of which received different information about the interviewees: 1) both were volunteers who were paid to participate 2) both were patients in a mental hospital
· Results: psychiatrists with clinical experience were more likely to be persuaded by the information given about the two interviewees and label them as mentally ill (if described as patients) or not ill (if described as volunteers
· Conclusion: shows labelling theory -> the behaviour of the person being diagnosed is not the most important component of diagnosis, and in an ambiguous situation of a diagnostic interview, any suggestion that the subject is/has been mentally ill will be a strong influence on a decision.
· Shows that simply being labelled as something affects the validity of the diagnosis
- psychiatrists need to take into account the past medical history of a person suffering from a mental illness – it can be a huge factor
- they couldn’t meet the interviewees in person/ask their own questions and so their diagnosis had to be based off of prior information
- lacks ecological validity – they couldn’t talk to the person themselves, it was just one time (normally they would have more sessions with a patient)
+ shows how diagnosis can not be valid
+ will allow psychiatrists to be aware of labelling theory
Conclusion
· Diagnoses are only valid and reliable to a certain extent
· Can change culturally depending on social/cultural norms
· Can change according to who is diagnosing the person
· One overall system for diagnosis may not be sufficient/efficient enough
· Criteria for mental illnesses shouldn’t be so vague and open to misinterpretation
· Should always be sure of a diagnosis before telling the patient
Intro:
· Classification of mental disorders – identification of groups/patterns of behaviour/symptoms to form the disorder
· Allows psychiatrists, doctors and psychologists to easily identify groups of similar sufferers
· Allows a suitable treatment
· Allows researchers to investigate these groups of people to find out the aetiology
· Major systems of diagnosis – DSM and ICD
· DSM – Diagnostic and Statistical Manual of Mental Disorder
· Mental disorder – clinically significant syndrome associated with distress, loss of functioning, increase risk of death/pain, loss of freedom
· Describes disorders so that two clinicians referring to the system would agree with the diagnosis suggested
· Utilises multi-axial diagnosis, encourages a more holistic approach to understanding the person. DSM undergoes constant revisions and adapts to changes in thinking overtime
· ICD – International Classification of Diseases
· More commonly used internationally than the DSM – covers diseases and conditions for the sake of classification rather than diagnosis
· ICD is primarily a classification system but includes details of what symptoms are required for diagnosis
· Define validity and reliability
· Reliability: for a diagnostic system to be reliable it must consistently make the same diagnoses
· Validity: for it to be valid, the diagnoses must identify a real pattern of symptoms and apply appropriate treatment
BP1: Reliability – negative
· Inter-rater reliability – assesses the agreement with which different clinicians diagnose conditions in the same patients
· Nicholls et al showed neither ICD or DSM demonstrated good inter-rater reliability for the diagnosis of eating disorders in children
· 81 patients, aged 6-17 years with eating problems
· Classified using ICD and DSM and a system developed for kids by Great Ormond Street Hospital (GOS)
· DSM: Over 50% of kids were not diagnosed. Reliability = 64% agreement between raters, but was at this level because most raters agreed they couldn’t make a diagnosis
· ICD: 36% reliability
· GOS 88% reliability
· GOS – specifically designed for young kids.
· In terms of eating disorders and possibly other disorders the reliability of well-known diagnostic systems (ICD, DSM) may not be very reliable
+ shows that systems can’t be so reductionist/generalised – they need to incorporate children as well
- perhaps the GOS is too simple/easy to diagnose, because if the DSM and the ICD didn’t pick up on an eating disorder, the children may not actually have one
+ good range of ages – shows that the GOS can be applicable to many ages
+ large participant pool
BP2: Reliability – positive
· Pedersen et al gave 10 Danish GPs one day’s training to use the IDC criteria for diagnosing depression
· Over next 8 weeks they diagnosed 116 patients with a depressive episode. 71% reliability with a diagnosis of depression – good inter-rater reliability for ICD-10 in the case of depression
+ shows good inter-rater reliability using the ICD
- if anyone can diagnose someone then people may start self-diagnosing using the ICD criteria, leading to more problems
- What percentage shows a positive or negative inter-rater reliability?
+ Large participant pool, increases reliability of results
- Only Danish GPs, perhaps had more experience dealing with depressed patients – Olsen et al (2004) found major depression to be of a high prevalence in the Danish general population.
BP3: Validity – negative
· Rosenhan et al – being sane in insane places
· 5 men, 3 women went to 12 different hospitals across USA complaining of hearing voices, but presented life history and present state as normal
· Voices said single words like “empty” “thud” – unclear, unfamiliar, of the same sex. These were the only symptoms reported
· Seven were admitted with a diagnosis of schizophrenia
· Once in hospital, they stopped complaining of symptoms and tried to get out
· Average of 19 days for the pseudo-patients to be released
· Psychiatric classification of the time of discharge was “schizophrenia in remission” (may come back).
· Rosenhan also wanted to see if abnormal individuals could be classified as normal. He told staff that pseudo-patients would try to gain admittance. No pseudo-patients actually appeared, but 41 real patients were judged with great confidence to be pseudo-patients
· Of these real patients, 19 were suspected of being frauds by one psychiatrist and one member of staff
· Conclusion: not possible to distinguish between sane and insane in psychiatric hospitals.
· Lack of scientific evidence on which medical diagnoses can be made – shows lack of validity in diagnosis because were only diagnosed on one symptom.
- Unethical study: could have taken away needed attention to real patients at the hospital. Hospital staff were deceived
+ 12 hospitals in the USA – large number, range of hospitals. Generalisation allowed
+ Tried both ways – abnormal and normal
+ Participant observation – pseudo-patients could experience the ward from the patients’ perspective whilst still maintaining a degree of objectivity
+ Fairly ecologically valid – field experiment
- Psychiatric hospitals perhaps should play it safe with diagnosis of abnormality for the safety of society
- Doctors and psychiatrists are more likely to make a type two error (healthy person sick) than type one
- Psychiatric classification in use was DSM-II. Has been updated numerous times – now on DSM-IV.
- Arguing that mental illness is a social phenomenon – a consequence of labelling.
BP4: Validity – negative
· Caetano (1973)
· Videoed a male psychiatrist carrying out separate standardised interviews with a paid university student and with a hospitalised mental patient
· Two groups of people shown the video – 1) 77 psychology students 2) 36 psychiatrists
· Asked to diagnose the interviewees and rate their degree of mental illness. With each sample of viewers, there was random assignment to two different groups, each of which received different information about the interviewees: 1) both were volunteers who were paid to participate 2) both were patients in a mental hospital
· Results: psychiatrists with clinical experience were more likely to be persuaded by the information given about the two interviewees and label them as mentally ill (if described as patients) or not ill (if described as volunteers
· Conclusion: shows labelling theory -> the behaviour of the person being diagnosed is not the most important component of diagnosis, and in an ambiguous situation of a diagnostic interview, any suggestion that the subject is/has been mentally ill will be a strong influence on a decision.
· Shows that simply being labelled as something affects the validity of the diagnosis
- psychiatrists need to take into account the past medical history of a person suffering from a mental illness – it can be a huge factor
- they couldn’t meet the interviewees in person/ask their own questions and so their diagnosis had to be based off of prior information
- lacks ecological validity – they couldn’t talk to the person themselves, it was just one time (normally they would have more sessions with a patient)
+ shows how diagnosis can not be valid
+ will allow psychiatrists to be aware of labelling theory
Conclusion
· Diagnoses are only valid and reliable to a certain extent
· Can change culturally depending on social/cultural norms
· Can change according to who is diagnosing the person
· One overall system for diagnosis may not be sufficient/efficient enough
· Criteria for mental illnesses shouldn’t be so vague and open to misinterpretation
· Should always be sure of a diagnosis before telling the patient
Discuss cultural and ethical considerations in diagnosis
· Intro:
· BP1: Culture (culture bound syndromes)
· Syndromes that do not fit easily into the categories/classifications of supposedly universal disorders.
· Occurs almost exclusively in specific locations/populations, are indigenously regarded to be illnesses. Have local names. Do not have cultural universality
· Gross: there are universal norms for disorders across cultures, but the symptoms may vary in ways that make them culturally exclusive. CBS limit this method of defining abnormal behaviour. Firstly, triggers of symptoms may not exist in other areas of the world for that particular abnormality, and are only available in certain areas. Secondly, the disorder may only be seen as a disorder in a specific area due to cultural beliefs. E.g Koro – irrational fear of genital shrinkage – China and India
· Different societies/cultures can disagree over what is abnormal behaviour
· Voodoo in one culture can be paranoia in another
· Homosexuality – considered to be a disorder for a long period of time to a point where homosexuals were sent to psychiatric hospitals.
· Over time people came out as being homosexual. Media also played a role in influencing a more positive representation of homosexuality, and as social norms are now slowly leaning towards homosexuality being accepted, it is no longer considered to be highly abnormal – however, again, this differs with various cultural and religious influences.
· Racism is disapproved but isn’t a mental illness. Also messiness, rudeness
· Impossible to achieve an objective definition of abnormal behaviour across cultures – may lead to unfair and discriminatory treatment of minorities to majorities
· Could be extremely difficult to diagnose
· Clinicians must take into account a person’s culture and previous experiences
· Cultural and ethnical factors play a role in diagnosis – between different cultures there is a different understanding of what is considered normal behaviour and what is considered to be a mental health disorder.
BP2: Culture
· Jenkins-Hall and Sacco
· Western (white) clinicians, asked them to watch interviews with possible patients
· 4 different conditions – White American non-depressed woman, white American depressed woman, African American non-depressed woman, African American depressed woman
· Findings: clinicians rated the non-depressed women the same, but were more likely to diagnose the African-American woman as depressed and less socially competent than White American
+ Shows cultural bias exists
· Clinicians must take this into account. For a more reliable diagnosis, more than one researcher from a different culture should assess a patient
· If people are given the wrong diagnosis it can be detrimental to health
+ controlled, more cause and effect
- Correlation, not causation
- Lacks ecological validity (diagnosis through video)
EXTRA STUDY #1: Erinosho et al – Nigeria tribe study
· Investigate cultural differences in criteria of normality and abnormality
· Participants: tribesmen from Yoruba tribe in Nigeria
· Information of patients with schizophrenia were presented to the tribe
· Only 40% of tribesmen identified the patient as mentally ill
· 30% said they’d marry such a person
· Could be due to cultural differences between tribesmen and the Western world
· Cultural consideration: may be ill in one culture and not another. Don’t be so quick to diagnose somebody
+ Importance of emic approaches in diagnosis
+ Shows influence of Western world on diagnosis
- Ability to identify the definition of “abnormality” in different cultures can only be done in culture specific approaches in studies, meaning a lot of research can be inaccurate
- Only with one tribe, could be an exception. Perhaps majority of other tribes vote the person as ill
- May say they are not ill but the person could still be detrimental to their health
- Marrying person – social desirability, perhaps wouldn’t actually marry them
EXTRA STUDY #2: Binitie – Schizophrenia in Nigeria
· Participants: Nigerians living in the city
· Information of patients with schizophrenia were presented to the participants
· Most participants identified patients as mentally ill
· 31% showed aggressive response to such patients (they should be expelled/shot)
· Shows how Western culture has influenced judgement of normality (compared with Yoruba tribe study)
+ Support of other study
- Perhaps Nigerians weren’t influenced by Western world, correlation not causation
- Aggressive responses aren’t natural in Western world either, so still could be just correlation and not a cause/influence of Westernisation
- Conformity à perhaps they wouldn’t define them as ill but conformed to other answers
- Just one culture (Nigerian) cannot generalise to all cultures and Western influence
· Schizophrenia could be a Western concept à tribal Nigerians did not see hallucinations as something negative
· Cultural relativism suggests that abnormality is subjective cross-culturally
BP3: Ethical issue (confirmation bias)
· Clinicians tend to attribute a patient’s behaviours to a disorder and looking for behaviours that confirm the disorder
· Rosenhan
· Assumption that if the patient is there in the first place, there must be something to diagnose
· Once the patients stopped exhibiting behaviours, they took notes on their experience. This was interpreted as a symptom of schizophrenia.
· When they were walking down the hallway, this was seen as a sign of nervousness.
· Shows that when a person is deemed mentally ill, any actions will be interpreted as symptoms of the disorder.
· However, maybe this is necessary for further research into a disorder. Psychiatrists have to be very careful to ensure that symptoms have died down before releasing patients
BP4: Ethical issue (stigmatisation)
· Labelling theory – once a diagnosis has been made, it tends to stick and results in negative effects of the diagnosis on the person’s subsequent treatment by other people.
· Langer and Abelson: showed a video of a younger man telling an older man about his job experience.
· If viewers were told he was a job applicant, he was judged to be attractive and conventional looking, but if told he was a patient, he was described negatively
· Important to emphasise the importance of taking in the ethical considerations before diagnosing patients so easily
+ Read: summarised a lot of research related to stigmatisation – findings: knowing someone has been diagnosed with a mental illness increases reluctance to enter into romantic relationships with them.
+ Sato: schizophrenia was renamed in Japan because of the stigma attached to it.
- Lacks ecological validity à wouldn’t normally make conclusions via video
- Demand characteristics (thoughts: “perhaps researchers want me to attribute him with negative traits because he is a patient”)
- Leading questions/descriptions (job applicant/patient). What about no description?
EXTRA STUDY #1: Farina et al
· Stigma and prejudice towards those labelled as mentally ill
· One member of a pair of male college students was falsely led to believe the other had been a mental patient. He perceived the pseudo ex-patient to be inadequate, incompetent and not likeable
+ Clearly shows stigma/prejudice
- Unethical à deception, undue stress
- Perhaps he genuinely thought these things about the participant
- No causal relationship, just correlation
- Just done on college students, cannot generalise that all adults will hold this stigma
- Just done to males à perhaps females are more considerate/open and welcoming
- Would someone who was mentally ill stigmatise someone who was ill? THOUGHT!
EXTRA THEORY #2: Stigmatisation – Szasz
· Serious ethical issues in diagnosis
· Szasz argued that people use labels such as ‘mentally ill’, ‘criminal’ or ‘foreigner’ in order to socially exclude people. People who are different à stigmatised
· Psychiatric diagnosis provides patient with a new identity (e.g “schizophrenic)
· This criticism influenced the classification systems à DSM-IV it is recommended to refer to “an individual with schizophrenia”
· Psychiatric diagnosis is a label for life à even if patient doesn’t show any symptoms, the label “disorder in remission” still remains
+ Supported by research (Farina et al à ex-patient still stigmatised)
+ DSM-IV was altered in accordance to this showing more support for the theory
+ Good effect: media campaigns against stigmatisation to represent illnesses semi-correctly
- Generalisation of all people stigmatising à individual differences/how people respond to mental illnesses
- Longitudinal studies would be needed to investigate if a social stigma is truly attached for life
- Sometimes a label is wanted à e.g ‘criminal’ is wanted in gangs and criminal sub-cultures
- Individual differences to how people respond to receiving the label (e.g some people may accept it whereas others may want to get over the illness)
Conclusion:
· Cultural differences must be considered when diagnosing a patient - for a more reliable diagnosis, more than one researcher from a different culture should assess a patient
· Some cultures may hide it (collectivistic/individualistic)
· When observing the disorder/symptoms of it, clinicians must be careful not to generalize all actions as symptoms
· Incredibly important to consider the ethical implications/stigma that comes with a diagnosis
· Psychologists should not diagnose someone so easily with a disorder because it could even further the disorder
· BP1: Culture (culture bound syndromes)
· Syndromes that do not fit easily into the categories/classifications of supposedly universal disorders.
· Occurs almost exclusively in specific locations/populations, are indigenously regarded to be illnesses. Have local names. Do not have cultural universality
· Gross: there are universal norms for disorders across cultures, but the symptoms may vary in ways that make them culturally exclusive. CBS limit this method of defining abnormal behaviour. Firstly, triggers of symptoms may not exist in other areas of the world for that particular abnormality, and are only available in certain areas. Secondly, the disorder may only be seen as a disorder in a specific area due to cultural beliefs. E.g Koro – irrational fear of genital shrinkage – China and India
· Different societies/cultures can disagree over what is abnormal behaviour
· Voodoo in one culture can be paranoia in another
· Homosexuality – considered to be a disorder for a long period of time to a point where homosexuals were sent to psychiatric hospitals.
· Over time people came out as being homosexual. Media also played a role in influencing a more positive representation of homosexuality, and as social norms are now slowly leaning towards homosexuality being accepted, it is no longer considered to be highly abnormal – however, again, this differs with various cultural and religious influences.
· Racism is disapproved but isn’t a mental illness. Also messiness, rudeness
· Impossible to achieve an objective definition of abnormal behaviour across cultures – may lead to unfair and discriminatory treatment of minorities to majorities
· Could be extremely difficult to diagnose
· Clinicians must take into account a person’s culture and previous experiences
· Cultural and ethnical factors play a role in diagnosis – between different cultures there is a different understanding of what is considered normal behaviour and what is considered to be a mental health disorder.
BP2: Culture
· Jenkins-Hall and Sacco
· Western (white) clinicians, asked them to watch interviews with possible patients
· 4 different conditions – White American non-depressed woman, white American depressed woman, African American non-depressed woman, African American depressed woman
· Findings: clinicians rated the non-depressed women the same, but were more likely to diagnose the African-American woman as depressed and less socially competent than White American
+ Shows cultural bias exists
· Clinicians must take this into account. For a more reliable diagnosis, more than one researcher from a different culture should assess a patient
· If people are given the wrong diagnosis it can be detrimental to health
+ controlled, more cause and effect
- Correlation, not causation
- Lacks ecological validity (diagnosis through video)
EXTRA STUDY #1: Erinosho et al – Nigeria tribe study
· Investigate cultural differences in criteria of normality and abnormality
· Participants: tribesmen from Yoruba tribe in Nigeria
· Information of patients with schizophrenia were presented to the tribe
· Only 40% of tribesmen identified the patient as mentally ill
· 30% said they’d marry such a person
· Could be due to cultural differences between tribesmen and the Western world
· Cultural consideration: may be ill in one culture and not another. Don’t be so quick to diagnose somebody
+ Importance of emic approaches in diagnosis
+ Shows influence of Western world on diagnosis
- Ability to identify the definition of “abnormality” in different cultures can only be done in culture specific approaches in studies, meaning a lot of research can be inaccurate
- Only with one tribe, could be an exception. Perhaps majority of other tribes vote the person as ill
- May say they are not ill but the person could still be detrimental to their health
- Marrying person – social desirability, perhaps wouldn’t actually marry them
EXTRA STUDY #2: Binitie – Schizophrenia in Nigeria
· Participants: Nigerians living in the city
· Information of patients with schizophrenia were presented to the participants
· Most participants identified patients as mentally ill
· 31% showed aggressive response to such patients (they should be expelled/shot)
· Shows how Western culture has influenced judgement of normality (compared with Yoruba tribe study)
+ Support of other study
- Perhaps Nigerians weren’t influenced by Western world, correlation not causation
- Aggressive responses aren’t natural in Western world either, so still could be just correlation and not a cause/influence of Westernisation
- Conformity à perhaps they wouldn’t define them as ill but conformed to other answers
- Just one culture (Nigerian) cannot generalise to all cultures and Western influence
· Schizophrenia could be a Western concept à tribal Nigerians did not see hallucinations as something negative
· Cultural relativism suggests that abnormality is subjective cross-culturally
BP3: Ethical issue (confirmation bias)
· Clinicians tend to attribute a patient’s behaviours to a disorder and looking for behaviours that confirm the disorder
· Rosenhan
· Assumption that if the patient is there in the first place, there must be something to diagnose
· Once the patients stopped exhibiting behaviours, they took notes on their experience. This was interpreted as a symptom of schizophrenia.
· When they were walking down the hallway, this was seen as a sign of nervousness.
· Shows that when a person is deemed mentally ill, any actions will be interpreted as symptoms of the disorder.
· However, maybe this is necessary for further research into a disorder. Psychiatrists have to be very careful to ensure that symptoms have died down before releasing patients
BP4: Ethical issue (stigmatisation)
· Labelling theory – once a diagnosis has been made, it tends to stick and results in negative effects of the diagnosis on the person’s subsequent treatment by other people.
· Langer and Abelson: showed a video of a younger man telling an older man about his job experience.
· If viewers were told he was a job applicant, he was judged to be attractive and conventional looking, but if told he was a patient, he was described negatively
· Important to emphasise the importance of taking in the ethical considerations before diagnosing patients so easily
+ Read: summarised a lot of research related to stigmatisation – findings: knowing someone has been diagnosed with a mental illness increases reluctance to enter into romantic relationships with them.
+ Sato: schizophrenia was renamed in Japan because of the stigma attached to it.
- Lacks ecological validity à wouldn’t normally make conclusions via video
- Demand characteristics (thoughts: “perhaps researchers want me to attribute him with negative traits because he is a patient”)
- Leading questions/descriptions (job applicant/patient). What about no description?
EXTRA STUDY #1: Farina et al
· Stigma and prejudice towards those labelled as mentally ill
· One member of a pair of male college students was falsely led to believe the other had been a mental patient. He perceived the pseudo ex-patient to be inadequate, incompetent and not likeable
+ Clearly shows stigma/prejudice
- Unethical à deception, undue stress
- Perhaps he genuinely thought these things about the participant
- No causal relationship, just correlation
- Just done on college students, cannot generalise that all adults will hold this stigma
- Just done to males à perhaps females are more considerate/open and welcoming
- Would someone who was mentally ill stigmatise someone who was ill? THOUGHT!
EXTRA THEORY #2: Stigmatisation – Szasz
· Serious ethical issues in diagnosis
· Szasz argued that people use labels such as ‘mentally ill’, ‘criminal’ or ‘foreigner’ in order to socially exclude people. People who are different à stigmatised
· Psychiatric diagnosis provides patient with a new identity (e.g “schizophrenic)
· This criticism influenced the classification systems à DSM-IV it is recommended to refer to “an individual with schizophrenia”
· Psychiatric diagnosis is a label for life à even if patient doesn’t show any symptoms, the label “disorder in remission” still remains
+ Supported by research (Farina et al à ex-patient still stigmatised)
+ DSM-IV was altered in accordance to this showing more support for the theory
+ Good effect: media campaigns against stigmatisation to represent illnesses semi-correctly
- Generalisation of all people stigmatising à individual differences/how people respond to mental illnesses
- Longitudinal studies would be needed to investigate if a social stigma is truly attached for life
- Sometimes a label is wanted à e.g ‘criminal’ is wanted in gangs and criminal sub-cultures
- Individual differences to how people respond to receiving the label (e.g some people may accept it whereas others may want to get over the illness)
Conclusion:
· Cultural differences must be considered when diagnosing a patient - for a more reliable diagnosis, more than one researcher from a different culture should assess a patient
· Some cultures may hide it (collectivistic/individualistic)
· When observing the disorder/symptoms of it, clinicians must be careful not to generalize all actions as symptoms
· Incredibly important to consider the ethical implications/stigma that comes with a diagnosis
· Psychologists should not diagnose someone so easily with a disorder because it could even further the disorder