OCR Psychology A Level Book 2 sample

Background and aims Key research The historical context of mental health Topic 1 The specification requires that you know one piece of key research for each topic. On this spread we take a look at the key research by David Rosenhan on the validity and reliability of diagnosis of mental disorder. For the exam you need to be able to link the key research to the topic (the historical context of mental health) and link the key research to methodological issues and debates. These links are considered on the next spread. Rosenhan’s question was whether a diagnosis of mental disorder relies on the context—the same behaviour might be seen as ‘mad’ if a person is in a psychiatric hospital but not if they were in a more ordinary environment. Results Diagnosis The pseudo-patients were all admitted and all but one given a diagnosis of schizophrenia and were eventually discharged with a diagnosis of ‘schizophrenia in remission’. They remained in hospital for seven to 52 days ( mean 19 days). No pseudo-patient was suspected by staff, but 35 of a total of 118 patients on the admissions ward suspected they were not real patients saying things like, ‘You’re not crazy. You’re a journalist, or a professor.’ Effect of labelling Normal behaviours shown by the pseudo-patients were often interpreted as symptoms of their disorder. For example, their queueing early for lunch was seen as pathological behaviour. Rosenhan reported one case of a pseudo-patient who described his very normal childhood and early adulthood, including normal relationship ups and downs. The staff interpreted this history as a schizophrenic reaction. Depersonalisation and powerlessness Patients lacked privacy, for example many of the toilets did not have doors, their personal hygiene was monitored and medical records could be accessed by any staff members regardless of their role. This depersonalisation led to an overwhelming feeling of powerlessness for the patients. This powerlessness was evident in many parts of the experience—patients were unable to initiate contact with staff and they were denied freedom of movement and privacy. Study 1 Aim The aim of the first study was to see whether a group of sane people presenting themselves as having a disorder would be diagnosed as insane by staff at psychiatric hospitals. Method Sample The participants were patients and staff at 12 psychiatric hospitals in five different states across America in the early 1960s. These hospitals varied in size, funding and age so there was a considerable range. Rosenhan asked eight ‘pseudo-patients’ to pretend to be suffering from a mental disorder and present themselves to the hospital for admission. These were not the participants of the study—they were ‘normal’ people, confederates who were instructed by Rosenhan about how to behave. There were three women and five men of various ages and included three psychologists (including Rosenhan), a psychology graduate student, a psychiatrist, a paediatrician, a painter and a ‘housewife’. Research method This was a participant observation because the pseudo-patients pretended to be real patients and recorded activity at the hospitals. Procedure Getting admitted The pseudo-patients telephoned the hospital to ask for an appointment. When they arrived at the admissions office they complained that they had been hearing voices, a common symptom of schizophrenia —though in fact the particular words used (‘empty’, ‘hollow’ and ‘thud’) were not normally linked with schizophrenia. All the other details the pseudo-patients gave to the hospital were true though all gave a false name and those who worked in mental health professions gave false jobs to avoid any special attention from staff. Behaviour once admitted After they had been admitted to the psychiatric ward, the pseudo- patients acted completely normally. When they were asked how they were feeling they said they no longer experienced symptoms. In order to be released from the hospital the pseudo-patients had to convince staff that they were sane—to do so they displayed exemplary behaviour—obeying instructions and not being disruptive in any way. The pseudo-patients wrote notes about their observations. In the 1960s psychiatrists and psychotherapists started to criticise the medical model of abnormality. This was known as the anti-psychiatry movement. David Rosenhan was part of this movement. He also had an interest in the law and observed that, in murder trials, the prosecution and defence each called their own psychiatrists who often disagreed on the defendant’s sanity. This led him to wonder whether there is any way to reliably identify who is abnormal. David L. Rosenhan (1973) On being sane in insane places. Science , 179, (4070), 250–258. Aims Rosenhan’s key question was whether a diagnosis of insanity is based on characteristics of the patients themselves or the context in which the patient is seen. Rosenhan was aware of previous attempts by researchers to admit themselves to psychiatric hospitals, but only for short periods of time, and often with the knowledge of the hospital staff. Rosenhan aimed to extend this research. Ultimately the aim was to test the validity and reliability of psychiatric diagnosis. Rosenhan (1973) on Being sane in insane places Chapter 1: Issues in mental health 16