Using studies from the list below, answer the questions which follow: Rosenhan (sane in insane places)Thigpen and Cleckley (multiple personality)Raine, Buchsbaum and LaCasse (brain scans)Freud (Little Hans)

Authors Avatar

2. A number of studies look at behaviour and experience that is sometimes defined as ‘abnormal’

Using studies from the list below, answer the questions which follow:

Rosenhan (sane in insane places)

Thigpen and Cleckley (multiple personality)

Raine, Buchsbaum and LaCasse (brain scans)

Freud (Little Hans)

  1. What problems did psychologists have when they tried to categorise and investigate abnormal behaviour in the above studies (10 marks)

Rosenhan ,D.L. (1973) ~ On being sane in insane places

There have been many attempts to classify what us abnormal behaviuor in history. The most used and most widely accepted approach to classifying abnormal behaviour is known as the medical model. This branch of medicine, which is concerned with treating mental illness, is known as psychiatry.  Commencing in the 1950s, this medical approach has used the Diagnostic and Statistical Manual of Mental Disorders (DSM) to classify abnormal behaviour.

However, in the 1960s, several psychiatrists and psychotherapists, who called themselves the anti-psychiatry movement, started to fiercely criticize the medical approach to abnormality. David Rosenhan was one of these psychiatrists and he was a critic of the medical model. His study can be seen as an attempt to demonstrate that psychiatric classification is unreliable.

The aim of Rosenhan’s study was to test the hypothesis that psychiatrists cannot reliably tell the difference between people who are sane and those who are insane. His study consisted of 2 parts.

The first part of the study involved a group of 8 ordinary ,'normal' and 'sane' people (a psychology graduate student in his 20s, 3 psychologists, a paediatrician, a psychiatrist, a painter and a ‘housewife) attempting to gain admission to 12 different hospitals, in 5 different states in the USA. There were 3 women and 5 men.

In the first study, none of the pseudo patients was detected and all except one were admitted with a diagnosis of schizophrenia and they were eventually discharged with a diagnosis of ‘schizophrenia in remission’. This diagnosis was made without one clear symptom of this disorder. Hence, this reinforces Rosenhan’s hypothesis that psychiatrists cannot reliably tell the difference between sane and insane people. It also implies that psychiatric diagnosis may be inaccurate and unreliable.They remained in the hospital for 7 to 52 days (average ~19 days). Visitors to the pseudo patients observed ‘no serious behavioral consequences’. Although the pseudo patients were not detected by the staff, the other patients suspected that they possessed sanity. Some patients even voiced their opinions very strongly, for example, ‘You’re not crazy. You’re a journalist, or a professor. You’re checking up on the hospital’.

Another problem encountered in categorizing and investigating abnormal behaviour in Rosenhan’s study was that once the patients were labeled as ‘abnormal’, this label stuck. Everything they did or said was interpreted as typical of a schizophrenic (or maniac depressive) patient. The hospital staff was not able to perceive the pseudo patients in isolation from their label and the fact that they were in a psychiatric hospital. This raises serious doubts about the reliability and validity of psychiatric diagnosis and suggests that psychiatric diagnoses of the staff were unreliable and lacked validity. For example, nursing records for three if the pseudo patients showed that their writing was seen as an aspect of their pathological behaviour (‘Patient engages in writing behaviour’).

Another example of where behaviour was misinterpreted by staff as stemming from within the patient, rather than the environment, was when a psychiatrist pointed to a group of patients waiting outside the cafeteria half an hour before lunchtime. To a group of registrars (trainee psychiatrists), the psychiatrist pointed out that such behaviour was characteristic of oral-acquisitive syndrome. However, a more likely explanation would have been that the patients had little to do and one of the few things to anticipate in a psychiatric hospital is a meal. Thus, this once more reinforces Rosenhan’s hypothesis that psychiatrics cannot reliably distinguish between sane and insane persons.

Critics charge the DSM-IV with focusing too much on the medical model, categorizing everyday problems as mental disorders, and overemphasizing problems or pathology. Hence, Rosenhan’s study illustrates that psychologists overemphasize pathology in diagnosis as this was present in the study.

In the secondary study, the staff of a teaching and research hospital, which was aware of the first study, as falsely informed that during the next 3 months, one or more pseudo patients would attempt to be admitted into their hospital, when in actuality there were no pseudo patients coming. The results/findings of this second study showed that many patients of the hospital’s regular intake were judged to be pseudo patients. For example, around 10% of their regular intake was judged by one psychiatrist and another staff member to be pseudo patients. Hence, this goes on to support the notion that psychiatric diagnosis may be unreliable and inaccurate and that psychiatrists may be erring in their judgement.

The table below shows the judgements of all admissions of patients (in Rosenhan’s 2nd study) as to the likelihood that they were pseudo patients.

The main experiment (the first study) illustrated a failure on the part of psychiatrists to detect sanity while the secondary study demonstrated a failure to detect insanity.

Another problem in Rosenhan’s study with the investigation and categorization of abnormal behaviour is the prevalence of observer bias, which means looking more at a particular group rather than another. An example of this is if a man was undertaking a study on the difference between men and women, he may focus more on women. This was a problem in the Rosenhan study: ‘On being sane in an insane places’. Those who were observing the pseudo patients with the other patients may have only tried to focus more on one particular group, and may have only taken down what they wanted to see, rather than what they had to see. This can be seen when the observers attributed abnormality to the patients’ writing behaviour and also when the patients were lined up and waiting for lunch prior to lunchtime.

However, it could be said that the real problem in categorizing and investigating abnormal behaviour lies not in the classification tool or the subsequent models such as the medical model. The problem lies in the attitudes and the views of the psychiatrists themselves. This was demonstrated in Rosehnan’s study as the observers exhibited certain attitudes and views in their practices, for example, they interpreted everything the pseudo patients did as pathological and abnormal because of the labels attached to the pseudo-patients.

The behaviour of the pseudo patients was shaped by their environment (for example, nurses may assume that signs of boredom are signs of anxiety) and if the environment does not allow the patients to display ‘normal’ behaviour it will be difficult for them to be seen as normal. An example of the environment hindering the pseudo patients from displaying normal behaviour was when the staff would ignore the pseudo patients’ attempts at starting conversations. Hence, this could lead to problems relating to accurately investigating and categorizing abnormal behaviour.

Another problem encountered in Rosenhan’s study when categorizing and investigating abnormal behaviour, was that the psychiatrists were more likely to make a type II error (i.e. more likely to call a healthy person sick) than a type I error (i.e. diagnosing a sick person as healthy).

Rosenhan's study helped to bring a change towards better classification tools such as the DSM III and the newer DSM IV (R). It showed that the consistency at that time was lacking, and despite the ethical concerns about the well being of the pseudo patients, the validity of his experiment far outweighed these concerns. However, perhaps the real solution to this problem of distinguishing the normal from the abnormal lies in a change in the psychiatrists’ views and attitudes from the medical, to the more psychological models.

Thigpen and Cleckley (1954)~ A case of multiple personality

Multiple Personality disorder (MPD) is defined in DSM-III as a dissociative neurotic disorder whereby two or more dissimilar personalities coexist within an individual. It is important to make a distinction between MPD and Schizophrenia. MPD is not a form of Schizophrenia. Schizophrenia can be characterized as a type of psychosis where contact with reality and insight are impaired. Other symptoms include hallucinations and delusions.

The aim of Thigpen and Cleckley’s case study was to provide an account of the psychotherapeutic treatment of a 25 year old woman (known as Eve White in the study) who was referred to them because of ‘severe and blinding headaches’. This case study was the first fully documented case of multiple personality disorder and it has no doubt led to the disorder being more easily recognized than at the time at which the study was conducted.

However, in categorizing and investigating the abnormal behavior of Eve White, the psychologists may encountered problems.

One problem could be the demand characteristics of the study. Demand characteristics are when people try and act in ways that are expected of them. This may have been a problem in the study of Thigpen and Cleckley, on multiple personality. Maybe the whole Eve White scenario was just acting to please the psychologists. Maybe she wanted to make a name for herself, therefore, acting the way in which the psychologists wanted her to, she might have made a name for herself and succeeded. This raises the possibility that the therapists could have been conned by a successful actress, thus, making their diagnosis of MPD in Eve White inaccurate and unreliable.

Since Thigpen and Cleckley’s study was retrospective (if the individual is asked to look back over his/her life), then memory may not be accurate and indeed, Eve White may have misled the researchers. The data may, therefore, be unreliable. Thus, Eve White may have provided the researchers with inaccurate information and there is the possibility arises that the researchers’ diagnosis of Eve White having MPD may be unreliable.

In addition, the researchers in the study may have been biased. The close relationship between the researcher and the participant may introduce bias. For example, in Thigpen and Cleckley’s case study, the moment that Eve Black (the other personality) appeared, the therapist viewed her in a different way compared to Eve White. For example, as Eve crossed her legs ‘the therapist noted from the corner of his awareness something distinctly attractive about them, and also this was the first time he had received such an impression’. For the therapist, this was viewed as a change in her personality but more objectively it can be explained as a change in his perceptions of her. Hence, this bias may have affected the investigation of Eve White’s disorder since, the therapist may have perceived Eve Black differently from that point onwards and this could have led to the findings of the study and the diagnosis of MPD in Eve White being inaccurate and unreliable.

Another problem in categorizing and investigating abnormal behaviour in this study that arises is that the argument arises that Eve White may have been treated as more of a subject than as a patient.

However, the diagnosis of MPD is very unreliable. For example, there are many more cases reported in the US than in the UK. This illustrates that some psychiatrists are more likely to diagnose MPD than others. In addition, there is an argument that is rising in popularity. It suggests that psychiatrists such as Thigpen and Cleckley are actually creating MPD by unwittingly leading patients into believing that they have the condition. Hence, this reinforces the notion that diagnosis of MPD is very unreliable. In addition, it also reinforces the notion that psychiatric diagnosis can be inaccurate and unreliable.

Join now!

Raine, Bauchsbaum and LaCasse (1997) ~ Brain abnormalities in murderers indicated by Positron Emission Tomography (PET)

The aim of Raine et al.’s study was to investigate both cortical and sub-cortical brain functioning using PET scans in a group of murderers who pleaded not guilty by reason of insanity (NGRI). It was hypothesized that these seriously violent individuals had localized brain dysfunction in the pre- frontal cortex, angular gyrus, amygdale, hippocampus, thalamus, and the corpus callosum, brain areas previously linked empirically or conceptually to violence. Conversely, no dysfunction was expected in other brain areas (caudate, putamen, globus pallidus, ...

This is a preview of the whole essay