OCR Psychology A Level Book 2 sample

Linking it together It is now time to take a critical look at the background spreads and key research you have studied so far. In the exam, you are likely to be asked to make links between what you have studied related to topic 1. You need to be able to: • Link the key research to the background spreads. • Link methodological issues to the key research and background spreads. • Link debates to the background spreads, topic area and to the key research. The historical context of mental health Topic 1 How the key research explains categorising mental health One of the background concepts for this chapter is ‘Categorising mental disorders’. So the question is, how does Rosenhan’s (1973) study illustrate this? This study warns us of the lack of reliability and validity in categorising and diagnosing mental illness. The pseudo-patients in Rosenhan’s study were categorised as having a mental illness based on simply telling the admissions staff that they had symptoms. This labelling led to them being treated differently and having their normal behaviours interpreted as part of a mental illness. This highlights how behaviour, notably mental illness, is likely to be interpreted according to the situation and context rather than the individual. The study supports the anti-psychiatry movement in that it criticises the idea that psychological illnesses can be diagnosed in the same way that physical illnesses can. Should Rosenhan’s study have been allowed to take place? It broke many ethical guidelines but had an enormous impact on attitudes towards mental health diagnosis. Links with methodological issues Validity Rosenhan’s study took place in real hospitals, with real staff and patients who were unaware of the study taking place. This means the behaviour they showed would be representative of their true behaviours. This enhances the external validity of the study. Despite being in a natural setting, Rosenhan managed to control many variables, for example the pseudo-patients who conducted the mini- experiments did so using standardised procedures . The pseudo- patients also presented themselves to the admissions department in a standardised way and all (except one whose data was excluded) adhered to the instructions to keep various details true to life and various personal details concealed. This allowed standardisation and therefore direct comparison between hospitals. This enhances the internal validity of the study. Reliability In Rosenhan’s study there was no direct comparison of the observations between the pseudo-patients in different hospitals. This could lead to questions about inter-observer reliability . However, observations seemed to be consistent with each other, with all pseudo-patients reporting similar experiences. Timothy Brown et al. (2001) considered the reliability of diagnosis. They used a sample of 362 adults, who were interviewed on two separate occasions, two weeks apart, by two different clinicians . Reliability of diagnosis was high, for example Brown et al. reported a correlation of +.67 for repeat diagnoses of depression using the DSM-IV—if one clinician diagnosed one particular disorder another also did, on most occasions. Brown classed this as ‘good agreement’, showing reliability between clinicians. When clinicians disagreed it was not disagreement over the symptoms, but over whether the symptoms met the threshold to be counted as being indicative of a disorder. This demonstrates high levels of reliability in a recent edition of the DSM . Sampling bias Rosenhan attempted to ensure the study was generalisable as he used a variety of hospitals across America. This meant that results would not be attributed to the type of hospital, but could be considered representative of all psychiatric hospitals in America. However, the hospitals were only in America. As different countries have different systems for psychiatric diagnosis and hospitalisation, the results cannot be generalised beyond America. Furthermore Rosenhan’s study was conducted in the early 1970s. Many factors related to psychiatric diagnosis and treatment have changed since then. Not least the DSM used when this study took place was version II—the disorders were not as well operationalised as they are today, different disorders were included and the system for diagnosis was different. Due to these factors the results may not apply to psychiatric hospitals in current times. Freud’s psychogenic viewpoint of mental illness (see page 11) also suffers from sampling bias as it was based primarily on data from patients in Vienna during the late 19th century. This means that the ideas and treatments may not apply to people from other areas, cultures or historical timeframes. Ethnocentrism Rosenhan (1973) argues that: ‘ normality and abnormality are not universal: What is viewed as normal in one culture may be seen as quite aberrant in another ’. This demonstrates how the classification and definition of disorders varies between cultures. Classification systems, such as the DSM, are almost entirely based on the social norms of the dominant culture in the West, and much of the DSM is based on research on white middle-class people. Therefore, classifications are relevant to that group, yet the same criteria are applied to people from different subcultures living in the West. This shows the ethnocentrism of the diagnostic systems that are used in the US and the UK. Defining abnormality is likely to be culture bound, for example the social norms definition is obviously bound by culture because social norms are defined by the culture. This means that many behaviours that society believes to deviate from social norms are decided by Western standards. Attempts have been made in DSM-5 to reduce any ethnocentric bias by including a part in Section III about cultural relativity and awareness. This section also includes culture-bound syndromes (mental illnesses unique to particular cultural groups such as Koro , when an individual has an overpowering belief that their genitals will shrink, retract and even disappear). However, it may be the case that, although there are many differences in the experience of mental illness throughout the world, there are more similarities than there are differences. Evaluation of research on the historical context of mental health Chapter 1: Issues in mental health 18