Abnormal Paper 2 ERQs

Question 1

‘Abnormality vs Normality Theories

Answer 1

Statistical Infrequency
Deviation from Social Norms
Jahoda 1950s
Rosenhan & Seligman 1980s

Question 2

Abnormality vs Normality Studies

Answer 2

Swami 2010s - deviation from social norms

Rosenhan 70s - psychiatric difficulties in identifying normality vs abnormality

Jenkins-Halls & Sacco 90s - implications of abnormality, labelling, stigmatization

Question 3

Context for Abnormality vs Normality

Answer 3

• abnormality vs normality creates diagnoses
• importance of diagnosis
• assumptions & biases in defining normality & abnormality
• methodological considerations in research/researcher bias
• historical influence of social norms on normality/abnormality
• historical progression of defining normality & abnormality
• ethical considerations related to labelling and stigmatisation

Question 4

Jahoda 1950s Abnormality Theory

Answer 4

Aim
- determine criteria for ideal mental health

Participants/Research
- field survey
- 740 adults responded to survey

Method
- Jahoda synthesised answers to model ideal mental health

Results
- CHEAAP
- capacity for growth
- health relationships
- environmental mastery (good daily functioning)
- autonomy/independence
- accurate perception if reality
- positive self perception

Implications
- abnormality is defined as a deviation from this

Evaluation:
- infeasible to achieve all six parameters
- most people would be classified as abnormal from this
- cannot measure degrees of abnormality as these are HARD TO QUANTIFY
- ‘realistic’, ‘accurate’ etc need further operationalisation
(turning abstract ideas into measurable)

Question 5

Statistical Infrequency Abnormality Theory

Answer 5

Definition:
- a behaviour is classified as abnormal if it is statistically unusual
- 1st threshold usually outside of the 95% most common in the range
- 2nd threshold 99%
- 3rd threshold 99.9% (severely abnormal)

Pros:
- simple, accessible, practical, quantifiable
- degree of abnormality can be understood

Cons:
- statistical norms change
- IQ increases 3 per 10 years
- statistically infrequent behaviour could be advantageous
- most people are statistically infrequent in ATleast one area

Question 6

Deviation from Social Norms Abnormality Theory

Answer 6

Definition:
- abnormality when falls outside boundaries of social accepted behaviour

Pros:

Cons:
- societies different globally and change over time
- this sets precedent to use abnormality as means of social control
- socially acceptable behaviour may still be maladaptive
- acceptability changes on social setting too

Question 7

Rosenhan & Seligman 1980s Abnormality Theory

Answer 7

MISO-UUV

• maladaptiveness (self destructive)
• irrationality (behaviours don’t make sense to others)
• suffering (subjective experience of ones state)
• observer discomfort
• unconventional (standing out, deviations from social norms)
• unpredictability (inconsistent actions)
• violation of morality (against common moral norms)

Limitations:
- abnormal behaviour may become adaptive
- a lot of this measure is subjective to observer (discomfort)
- unconventional behaviour (extreme sports)

Question 8

Swami 2010s deviation from social norms Study

Answer 8

Aim
- To investigate the role of gender bias in diagnosis

Participants
- 1218 british adults

Method
- participants given a description of a persons symptoms which corresponded to depression of DSM IV
- the only difference was that half got the name of a female & other name of male
- asked to determine whether description had mental health disorder

Results
- participants were more likely to indicate the male did NOT suffer a disorder
- whereas women were more likely to be indicated as suffering

Implications
- although done on members of the public (not psychiatrists) that cultural norms impact how we interpret the same symptoms to be abnormal vs normal

Question 9

Rosenhan 70s psychiatric difficulties in identifying normality vs abnormality Study

Answer 9

Aim
- To determine psychiatry hospital’s ability to detect sanity

Participants/Research
- Naturalistic Observational Study
- 8 sane people
- 3 psychologists, 2 doctors

Method
- each participant called various psychiatric hospitals
- they claimed they were hearing voice with negative commands
- they answered every question honestly except name and address
- once admitted to hospital they stopped their ‘symptoms’ acting normal/sane

Results
- all admitted to hospital
- 7 diagnosed SZ, 1 bipolar
- never discovered
- all classified as “in remission” not sane
- oral acquisitive syndrome
- average 19 days stay 7-52 range
- over 70% of psychiatrists & nurses ignored the participants when asked for request

Implications
- psychiatrists unable to detect sanity
- behaviour was distorted to fit into label of abnormality
- DSM-II is not effective in identifying sanity
- depersonalisation/dehumanisation of misdiagnosis

Further:
- psuedo patients would be sent to psychiatric hosptial
- staff were told to detect them
- Rosenhan gave none
- hospital detected 41 pseudo patients

Evaluation:
Pros:
- connection to confirmation & labelling bias AND schema theory
- ecological validity

Cons:
- limited sample size not generalisable to all hospitals however, significant statistical result
- researcher bias as the observations were made by participants which included researchers, doctors & rosenhan himself
- ethical concerns:
- deception of hospital staff
- undue stress
- lack of informed consent
- no right to withdraw

Question 10

Jenkins-Halls & Sacco 90s implications of abnormality, labelling, stigmatization Study

Answer 10

Aim
- To investigate the influence of racial bias in the diagnosis of MDD

Participants/Research
- True experiment
- data triangulation (multiple rating systems , increasing validity)
- 60+ White psychotherapists from USA

Method
- Participants watched a 3-minute pseudo-consultation between a client and a therapist (the participant thought the consultation was real)
- 4 various of the pseudo-consultation: white acting depressed, black acting depressed, white acting non-depressed, black acting non-depressed—(scripted answers based on symptoms from standardised depression inventory and DSM)
- After watching the video, the participants answered a questionnaire to rate the depressive symptoms, social skills, and psychological state of the pseudo-client

Results
- The participants correctly diagnosed/rated the depressed condition corresponding to their symptoms, and in non-depressive condition to a similar degree regardless of race
- However, the participants gave significantly lower ratings for social skills, and likeability to black depressed pseudo-clients than white depressed pseudo-clients

Implications
- Therapists susceptible to racial bias in diagnosis as the depressed Black clients were viewed more negatively which would result in adverse and unfairly harmful treatment
- Good contrast to Swami (2012) because yes therapists may be able to avoid societal stereotypes in diagnosis, however, may still impact the treatment of minority groups by health professionals, as these societal stereotypes lead to different treatment of clients

Evaluation:
Pros:
- reliable with previous racial bias studies
- data triangulation thus validity of results
- applications on stigmatisation

Question 11

Classification System(s) Theory

Answer 11

DSM (general)
- diagnostic and statistical manual
- American Psychiatric Association
- USA, UK, Australia

(ICD)
- international classifications of diseases
- world health organisation
- europe

DSM-I & DSM-II
- 1952
- based on psychoanalytic traditions
- finding causes to abnormal behaviour (reliant on interpretation)
(homosexuality)
- disorder from 1952-1973
- quietly removed
- psychological disorders are cultural deviations
- DSM is ethnocentric social norms
- pathologizing deviant behaviour as mental illnesses

DSM-III
- 1980
- post Rosenhan
- shift towards objectivity
- describing psychological disorders through observable symptoms
- hardcore medical and biological approach to classifying mental illness through ‘medical checklist’
- expansion NOT born from observed and unaccounted abnormality
- further diagnoses otherwise ‘normal’
people
- invalid diagnoses of mental abnormality

DSM-IV
-1994
- post Lipton&Simon
- reduce overdiagnosis from prior DSM
- included clinical significance criteria

Question 12

Lipton & Simon 80s DSM-III Study

Answer 12

Aim
- investigate reliability of diagnoses

Participants/Research
- field experiment
- 131 PATIENTS
- 7 external clinicians to reevaluate their diagnoses

Method
- 7 clinicians re-evaluated and diagnosed the patients from a different psychiatric hospital to determine the reliability

Results
- only 18% of patients originally had SZ had been re-diagnosed
- 50 patients diagnosed w/ mood disorder after reevaluation
- only 15 had originally received a mood disorder prior

Implications
- same symptoms do not correspond with same diagnosis from another psychiatrist
- questioning reliability of DSM & of defining abnormalities

Question 13

Classification System(s) Studies

Answer 13

Rosenhan 70s - DSM-II
Lipton & Simon 80s - DSM-III
Lobbestael, Leurgans & Arntz 2010s - DSM-IV

Question 14

Context for Classification System(s)

Answer 14

Purpose:
- reliable & valid method of diagnosing psychological disorders
- range of psychiatrists arrive at the same diagnosis with same symptoms
- minimising cultural, clinical, biases & subjectivity
- psychological experience of patient corresponds to diagnosis received

• cross-cultural reliability
• validity & reliability
• minimising clinical biases & subjectivity
• lack of biological evidence (still marketed as such for treatments)
• expansion of DSM (more abnormality according to DSM)
• comorbidity (polypharmacy, difficult treatments & reduced efficacy)
• ethnocentrism (conforming to white Christian cultural norms vs deviation)
• Diagnostic manuals practical importance to clinicians making accurate, reliable diagnoses
• Underlying ssumptions and biases
• Problems of comorbidity
• Reliability & validity of diagnosis using classification systems
• Ethical considerations in diagnosis labelling and stigmatisation
• Comparison of different classification systems
• Areas of uncertainty.
• Cross-cultural validity in diagnosis
• Symptomology versus causation or explanation versus description

Question 15

Lobbestael, Leurgans & Arntz 2010s DSM-IV Study

Answer 15

Aim
- To investigate the reliability of diagnosis using the DSM IV (4)

Participants/Research
- Single double blind procedure
- 151 participants which underwent clinical interviews for mental health diagnoses

Method
- Clinical interviews between a psychiatrist and participant were audio-taped, and the participant was given a diagnosis based off this interview.
- A second psychiatrist which did not know the diagnosis of the first psychiatrist listened to the audio of the clinical interview to then form their own diagnosis

Results
- Personality disorders were more likely, than other mental illnesses, to be diagnosed reliability across the first and second psychiatrist
- 71% reliability in diagnosis of MDD
- 84% reliability in diagnosis of personality disorders

Implications
- High rate of consistent diagnosis indicates the DSM IV is reliable across clinicians as there is more agreement on diagnosis.
- however reliable diagnoses does not necessarily mean the diagnoses are valid

Question 16

The role of Clinical Biases Diagnosis Studies

Answer 16

Swami 2010s - gender bias
Jenkins-Halls & Sacco 90s - racial bias
Rosenhan 70s - labelling & confirmation bias

clinical biases - any cognitive bias that affects the validity of a diagnosis

Question 17

Context for Clinical Biases

Answer 17

• definitions of gender bias
• definitions of racial bias
• definitions of labelling bias
• definitions of confirmation bias
• causes of bias (schema) (cultural)
• implications of biases (validity, stigmatization, prejudice, defining normality vs abnormality)
• historical examples of bias influencing diagnoses

Question 18

Gender bias Study

Answer 18

Swami - males and females are associated more with different disorders due to gendered expectations
- and so more likely to be diagnosed w mental illness which matches gender stereotype
- than other gender w same symptoms

Question 19

Validity & Reliability of Diagnosis Studies

Answer 19

Rosenhan 70s - diagnostic validity
Lipton & Simon 80s - diagnostic reliability
Lobbestael, Leurgans & Arntz 2010s - diagnostic reliability

Question 20

Context for Validity & Reliability

Answer 20

validity
- accurately measuring (objectivity)
- classifying symptoms that lead to an effective treatment as this would mean the diagnosis is true

reliability
- multiple people agree & come to same conclusion
- multiple psychiatrists agree to diagnosis in accordance to same symptoms

• importance of diagnoses connected to validity & reliability
• contextualising the importance of validity with DSM
• contextualising the importance of reliability with DSM
• implications of validity and reliability on defining of normality & abnormality
• methodological challenges of researching validity/reliability of diagnoses
• biases which influence validity/reliability
• supporting and/or contradictory findings // areas of uncertainty
• applications of the research in real-world

Question 21

Ethical Considerations of Research into Factors Influencing Diagnosis Studies

Answer 21

Lipton & Simon 80s
Jenkins-Halls & Sacco 90s
Rosenhan 70s

Question 22

Contexts to Ethical Considerations in Diagnosis Research

Answer 22

• current ethical guidelines
• changes over the years to improve ethical guidelines in psychology
• importance of following ethical guidelines
• explanation how ethical guidelines can be achieved
• deception (justifications)
• right to withdraw
• DRIP-CD
• anonymity
• undue stress and harm + labelling and stigma
• cost-benefit analysis of whether research is valuable
• voluntary participation
• role of the researcher
• informed consent
• difficulties in ensuring confidentiality

Question 23

Ethical Studies

Answer 23

Lipton & Simon 80s ethical consideration Study

Jenkins-Halls & Sacco 90s ethical consideration Study

Rosenhan 70s ethical consideration Study

Question 24

Research Methods into Factors Influencing Diagnosis Studies

Answer 24

Jenkins-Halls & Sacco 90s true experiment?
Lipton & Simon 80s field experiment?
Rosenhan 70s natural experiment?

Question 25

Validity and reliability of diagnosis Studys

Answer 25

Rosenhan (1973)
Lipton & Simon (1985)
Lobbestael, Leurgans & Arntz (2011)

Question 26

Clinical Biases of Diagnosis Studies

Answer 26

Swami (2012) Gender Bias
Jenkins-Halls & Sacco Racial Bias
Rosenhan (1973) labelling & confirmation bias

Question 27

Classification systems Studies

Answer 27

Rosenhan (1973)
Lipton & Simon (1985)
Lobbestael, Leurgans & Arntz (2011)

Question 28

Harm & Difficulty of diagnoses

Answer 28

Psychiatric diagnosis cannot be observed and categorised objectively like physical diagnosis and thus lend to more subjective interpretations which may implicate the invalidity and or unreliability of psychiatric diagnoses
Psychiatric diagnosis more so are descriptions / categories which describe a pattern of symptoms wherein certain behaviours and traits tend to show up together which can then be labelled under a psychiatric diagnosis
These certain symptoms of psychiatric disorders—the grouped together behaviours and traits—are prevalent in many ‘normal’ individuals, however what distinguishes an abnormality is the degree to which the symptoms of psychiatric disorders are expressed—a degree above the threshold which is deemed ‘normal’, however, this threshold is highly subjective, and gets changed over time. Discerning normal presentations of psychiatric symptoms to abnormal ones which require treatment and intervention are sought to be achieved through definitions of normality, and abnormality. However, where these definitions are flawed, as they often are as they seek to categorise fluid human behaviour into a binary of normal or abnormal, has severe ramifications on individuals due to the stigma, and pathologisation of behaviour attached to psychiatric diagnoses. Hence critically analysing and evaluating definitions of normality and abnormality may better allow the achievement of accurate and valid diagnoses, mitigating undue harm from misdiagnosis, and lead to successful interventions.
This threshold is wherein definitions of normality vs. abnormality come in. for example, if the symptoms are to a degree which significantly impairs ones functioning in daily life
However, the certain degree and symptoms of psychiatric disorders which may be impairing to an individual in one context may actually not impair an individual in another context if the society or time period were to change as the demands and expectations of an individual’s life would differ, thus demonstrating the relativity of normality vs. abnormality
Behaviours once viewed as morally deviant and socially disruptive has historically been pathologised in order to maintain societal order and uphold specific power dynamics. And this is why achieving an accurate definition of true abnormality and normality is crucial—so that social biases do not impede valid diagnosis for ends of social conformity

Question 29

Importance of achieving accurate diagnoses (classification, validity/reliability, normality)

Answer 29

E.g. An example of psychiatric diagnoses being influenced by social values with regard to the DSM is homosexuality. Homosexuality was in the DSM in the 70s because it was considered abnormal, and psychiatric labels have been used and can still be used to reinforce the values of the cultural/social time, however, if these values are harmful or oppressive, as this historical example exemplifies, they can be invalid and weaponized for oppression in stead of reflecting a genuine abnormality. A modern example MAY be oppositional defiant disorder (ODD) which is diagnosed onto children which resit authority. ODD has experienced criticism for over-diagnosis, and pathologising normal childhood behaviour. ODD is also disproportionately applied to children from black and latino heritage which are marginalised racial groups. Both historical and modern examples reflect that psychiatric diagnosis often serve to reinforce subjective cultural values, biases, and power dynamics. In the example of ODD, the power dynamic that children are meant to be obedient and submit to adult authority becomes medicalised and reinforced through the ODD diagnosis making any deviation from this power dynamic an abnormality.

Clinical diagnoses are not necessarily a scientifically objective assessment of an individual. Psychiatric structures are power structures hence fallible and capable to reinforcing hegemony, however, often go without critical evaluation as a scientifically rigorous, and objective body.